Provider Demographics
NPI:1407928807
Name:F G L LERNER MD SERVICES LTD
Entity type:Organization
Organization Name:F G L LERNER MD SERVICES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-842-3700
Mailing Address - Street 1:2100 S INDIANA AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1381
Mailing Address - Country:US
Mailing Address - Phone:312-842-3700
Mailing Address - Fax:
Practice Address - Street 1:2100 S INDIANA AVE
Practice Address - Street 2:STE 111
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1381
Practice Address - Country:US
Practice Address - Phone:312-842-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty