Individual
DR. LAWRENCE MERION LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(260) 414-4990
Mailing address
1 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(260) 414-4990
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
036-049364
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036049364
IL
Other
Enumeration date
01/24/2006
Last updated
12/14/2011
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