Provider Demographics
NPI:1174560338
Name:BARR, LAWRENCE ALLEN (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ALLEN
Last Name:BARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E BRUSH HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5661
Mailing Address - Country:US
Mailing Address - Phone:331-231-6200
Mailing Address - Fax:331-231-6201
Practice Address - Street 1:133 E BRUSH HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5661
Practice Address - Country:US
Practice Address - Phone:331-231-6200
Practice Address - Fax:331-231-6201
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064451207RI0011X
IL036.064451207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064451Medicaid
060015692OtherRAILROAD MEDICARE
060015692OtherRAILROAD MEDICARE
IL923162Medicare PIN