Provider Demographics
NPI:1700886223
Name:LAWRENCE LEVENTHAL MD PC
Entity Type:Organization
Organization Name:LAWRENCE LEVENTHAL MD PC
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:LEVENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-342-5800
Mailing Address - Street 1:801 W TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2168
Mailing Address - Country:US
Mailing Address - Phone:217-342-5800
Mailing Address - Fax:217-347-3311
Practice Address - Street 1:801 W TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2168
Practice Address - Country:US
Practice Address - Phone:217-342-5800
Practice Address - Fax:217-347-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211092Medicare PIN
IL202883Medicare ID - Type Unspecified
A27954Medicare UPIN
IL4813120001Medicare NSC