Provider Demographics
NPI:1063733400
Name:LAWRENCE M KAUFMAN, M.D., PH.D., SC
Entity type:Organization
Organization Name:LAWRENCE M KAUFMAN, M.D., PH.D., SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:773-235-2020
Mailing Address - Street 1:2456 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2012
Mailing Address - Country:US
Mailing Address - Phone:773-235-2020
Mailing Address - Fax:773-235-2037
Practice Address - Street 1:2456 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2012
Practice Address - Country:US
Practice Address - Phone:773-235-2020
Practice Address - Fax:773-235-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074319Medicaid
IL31603018OtherBLUE CROSS BLUE SHIELD
IL1407019524Medicaid
IL1407019524Medicaid