Provider Demographics
NPI:1699861682
Name:KACMAR, LAWRENCE TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:TIMOTHY
Last Name:KACMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3965 75TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7925
Mailing Address - Country:US
Mailing Address - Phone:630-375-1625
Mailing Address - Fax:630-375-1925
Practice Address - Street 1:3965 75TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7925
Practice Address - Country:US
Practice Address - Phone:630-375-1625
Practice Address - Fax:630-375-1925
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091557207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091557Medicaid
IL17167232OtherUNITED HEALTHCARE
IL0002232125OtherBLUECROSS/BLUESHIELD
ILG53040Medicare UPIN
IL0002232125OtherBLUECROSS/BLUESHIELD