Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | IL |
NPI | 1023021821 |
---|---|
Provider Name | Lawrence Leventhal |
First Address | Effingham, IL 62401-2168 |
Second Address | Effingham, IL 62401-2168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 18/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A27954 | (02) |