Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036087808 | IL |
NPI | 1053315721 |
---|---|
Provider Name | Lawrence Neal Stein |
First Address | Smithton, IL 62285-3664 |
Second Address | Smithton, IL 62285-3664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 20/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036087808 | (05) | IL |
A78825 | (02) | IL |