Provider Demographics
NPI:1932183597
Name:LAVEAU, RICHARD J (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:LAVEAU
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 1:1815 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6817
Mailing Address - Country:US
Mailing Address - Phone:847-255-4111
Mailing Address - Fax:847-590-0160
Practice Address - Street 1:1815 E GROVE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6817
Practice Address - Country:US
Practice Address - Phone:847-255-4111
Practice Address - Fax:847-590-0160
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL518300Medicare PIN
ILT36799Medicare UPIN