Provider Demographics
NPI:1700802501
Name:KENFIELD, LAURIE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KENFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 EUCLID AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3472
Mailing Address - Country:US
Mailing Address - Phone:708-749-9060
Mailing Address - Fax:708-749-0429
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-442-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
K29717Medicare ID - Type Unspecified
E18669Medicare UPIN