Provider Demographics
NPI:1720134422
Name:LANTVIT, TIMOTHY T (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:T
Last Name:LANTVIT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0917
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:847-504-5015
Practice Address - Street 1:40 SKOKIE BLVD STE 520
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1601
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:847-504-5015
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000775213E00000X
IL016004656213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0732240001OtherDMERC # WITH PPG
IN200136470AMedicaid
IAP01770673OtherRAILROAD MEDICARE
IA1720134422Medicaid
IL016004656Medicaid
IL480017047OtherRAILRAOD MEDICARE
IL0002219563OtherBCBS
IN859800PMedicare PIN
IL753600004Medicare PIN
ILL58505Medicare PIN
ILL77309Medicare PIN
0732240001OtherDMERC # WITH PPG
IL480017047OtherRAILRAOD MEDICARE
ILL77308Medicare PIN
ILL77310Medicare PIN
IN200136470AMedicaid
IA1720134422Medicaid