Provider Demographics
NPI:1568813269
Name:NELSON, LANCE RONALD (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:RONALD
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2644
Mailing Address - Country:US
Mailing Address - Phone:312-227-6800
Mailing Address - Fax:
Practice Address - Street 1:1440 N DAYTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2644
Practice Address - Country:US
Practice Address - Phone:319-384-7888
Practice Address - Fax:319-384-7899
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1608912080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine