Provider Demographics
NPI:1124142948
Name:LAWRENCE D WOLIN MD SC
Entity type:Organization
Organization Name:LAWRENCE D WOLIN MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-255-3515
Mailing Address - Street 1:1602 W CENTRAL ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-255-3515
Mailing Address - Fax:847-255-8727
Practice Address - Street 1:1602 W CENTRAL ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-255-3515
Practice Address - Fax:847-255-8727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE D. WOLIN, M.D.,S.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2599030001OtherMEDICARE DMERC