Provider Demographics
NPI:1255357331
Name:LAWN MEDICAL CENTER, S.C.
Entity type:Organization
Organization Name:LAWN MEDICAL CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAJDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-425-5500
Mailing Address - Street 1:4301 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2670
Mailing Address - Country:US
Mailing Address - Phone:708-425-5500
Mailing Address - Fax:708-425-0771
Practice Address - Street 1:4301 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2670
Practice Address - Country:US
Practice Address - Phone:708-425-5500
Practice Address - Fax:708-425-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL604430Medicare ID - Type Unspecified