1417410077 NPI number — DR. ALEXANDER MICHAEL LAWSON DPM

Table of content: DR. ALEXANDER MICHAEL LAWSON DPM (NPI 1417410077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417410077 NPI number — DR. ALEXANDER MICHAEL LAWSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWSON
Provider First Name:
ALEXANDER
Provider Middle Name:
MICHAEL
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:
1417410077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 FEEHANVILLE DR STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PROSPECT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60056-6023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-627-4920
Provider Business Mailing Address Fax Number:
847-299-6041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24024 BRANCASTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-8044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-627-4920
Provider Business Practice Location Address Fax Number:
847-299-6041
Provider Enumeration Date:
04/10/2019

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: 213ES0103X , with the licence number:  016005980 , 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)





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