Provider Demographics
NPI:1669654513
Name:LAWRENCE D. WOLIN, M.D.,S.C.
Entity type:Organization
Organization Name:LAWRENCE D. WOLIN, M.D.,S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-255-3515
Mailing Address - Street 1:1602 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2407
Mailing Address - Country:US
Mailing Address - Phone:847-255-3515
Mailing Address - Fax:847-255-8727
Practice Address - Street 1:1602 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2407
Practice Address - Country:US
Practice Address - Phone:847-255-3515
Practice Address - Fax:847-255-8727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE D. WOLIN, M.D.,S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-03
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059451207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059451Medicaid
IL1623380OtherBCBS
IL180037165OtherMEDIARE RAILROAD
ILC38048Medicare UPIN
IL036059451Medicaid
IL1623380OtherBCBS