Provider Demographics
NPI:1831362409
Name:JECKEL, LAWRENCE LEE (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:LEE
Last Name:JECKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GALEN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7038
Mailing Address - Country:US
Mailing Address - Phone:217-356-0228
Mailing Address - Fax:217-356-0667
Practice Address - Street 1:2500 GALEN DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-7038
Practice Address - Country:US
Practice Address - Phone:217-356-0228
Practice Address - Fax:217-356-0667
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry