Provider Demographics
NPI:1447247572
Name:LENGEMANN, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LENGEMANN
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 1:1331 W 75TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9311
Mailing Address - Country:US
Mailing Address - Phone:630-527-5000
Mailing Address - Fax:630-527-5440
Practice Address - Street 1:1331 W 75TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9311
Practice Address - Country:US
Practice Address - Phone:630-527-5000
Practice Address - Fax:630-527-5440
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096442 1Medicaid
IL2221474OtherBCBS
G69308Medicare UPIN
IL036096442 1Medicaid
ILL64138Medicare PIN