Individual
LAWRENCE NICHOLAS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S FIRST AVE, (MAGUIRE CENTER, RM. 3307), MAYWOOD, IL 60153
(708) 216-4403
(708) 216-3375
Mailing address
2160 S FIRST AVE, (MAGUIRE CENTER, RM. 3307), MAYWOOD, IL 60153
(708) 216-4403
(708) 216-3375
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
36071262
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36071262
—
IL
Enumeration date
02/15/2006
Last updated
08/14/2009
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