Basic Information
| Provider Information | |||||||||
| NPI: | 1861575037 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | L BARNES LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 W MADISON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606444040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732611200 | ||||||||
| FaxNumber: | 7732611212 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W 159TH ST | ||||||||
| Address2: | |||||||||
| City: | MARKHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604284051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083335250 | ||||||||
| FaxNumber: | 7732611212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARNES | ||||||||
| AuthorizedOfficialFirstName: | LAVERNE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7732611200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.