Provider Demographics
NPI:1952628018
Name:L LERNER MD SC
Entity Type:Organization
Organization Name:L LERNER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-494-5855
Mailing Address - Street 1:600 N MCCLURG CT
Mailing Address - Street 2:SUITE 507A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3044
Mailing Address - Country:US
Mailing Address - Phone:708-494-5855
Mailing Address - Fax:312-787-2427
Practice Address - Street 1:600 N MCCLURG CT
Practice Address - Street 2:SUITE 507A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3044
Practice Address - Country:US
Practice Address - Phone:708-494-5855
Practice Address - Fax:312-787-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619614207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13223Medicare UPIN
IL214156Medicare PIN