Basic Information
| Provider Information | |||||||||
| NPI: | 1124158936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TERRENCE T. LERNER, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 N HALSTED ST | ||||||||
| Address2: | SUITE 625 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737677414 | ||||||||
| FaxNumber: | 7732965009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | LERNER | ||||||||
| AuthorizedOfficialFirstName: | TERRENCE | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7737677414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 11041 | 01 | IL | ADVOCATE HLTH PARTNERS | OTHER | DE5854 | 01 | IL | RAIL ROAD MEDICARE | OTHER | 31601535 | 01 | IL | BCBS PROVIDER ID | OTHER |