Individual
DR. DONALD BENJAMIN LASSUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4747 N. KEDZIE AVENUE, CHICAGO, IL 60625
(312) 666-3494
(773) 267-2175
Mailing address
1701 W. SUPERIOR, 3RD FLOOR, CHICAGO, IL 60622
(312) 666-3494
(312) 432-4354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036135721
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-135721
IL LIC
IL
05
—
036135721
—
IL
Enumeration date
07/08/2010
Last updated
08/10/2021
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