Individual
MR. LANCE A KIRBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
16525 W 159TH ST, LOCKPORT, IL 60441-7900
(708) 720-0148
Mailing address
16525 W 159TH ST, LOCKPORT, IL 60441-7900
(708) 720-0148
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085000829
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL5686066
MEDICARE PTAN
IL
Enumeration date
05/10/2006
Last updated
10/14/2024
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