Individual
DR. TIMOTHY T LANTVIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
40 SKOKIE BLVD STE 520, NORTHBROOK, IL 60062-1601
(847) 504-5000
(847) 504-5015
Mailing address
PO BOX 917, NORTHBROOK, IL 60065-0917
(847) 504-5000
(847) 504-5015
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004656
IL
213E00000X
Podiatrist
07000775
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002219563
BCBS
IL
05
—
016004656
—
IL
01
—
0732240001
DMERC # WITH PPG
—
05
—
1720134422
—
IA
05
—
200136470A
—
IN
01
—
480017047
RAILRAOD MEDICARE
IL
01
—
P01770673
RAILROAD MEDICARE
IA
Enumeration date
01/26/2007
Last updated
01/22/2019
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