Individual
LAWRENCE CANADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
651 S WELLS ST APT 706, CHICAGO, IL 60607-4547
(907) 414-0620
Mailing address
1210 S INDIANA AVE APT 1316, CHICAGO, IL 60605-2773
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/18/2019
Last updated
11/06/2023
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