Individual
LAWRENCE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8103 BURDEN RD, MACHESNEY PARK, IL 61115-8208
(815) 713-2600
(815) 654-8020
Mailing address
8103 BURDEN RD, MACHESNEY PARK, IL 61115-8208
(815) 713-2600
(815) 654-8020
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36089481
IL
2086S0127X
Trauma Surgery Physician
Primary
036-089481
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4673170001
DMERC
IL
01
—
P00470671
RAILROAD MEDICARE
IL
Enumeration date
12/29/2005
Last updated
06/13/2008
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