1720134422 NPI number — DR. TIMOTHY T LANTVIT DPM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720134422 NPI number — DR. TIMOTHY T LANTVIT DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANTVIT
Provider First Name:
TIMOTHY
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720134422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 917
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60065-0917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-504-5000
Provider Business Mailing Address Fax Number:
847-504-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 SKOKIE BLVD STE 520
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-504-5000
Provider Business Practice Location Address Fax Number:
847-504-5015
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  07000775 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 016004656 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0732240001 . This is a "DMERC # WITH PPG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200136470A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01770673 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720134422 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016004656 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480017047 . This is a "RAILRAOD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0002219563 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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