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28379 Davis Pkwy Suite 801 Warrenville IL 60555-3032 | |
| (630) 393-9800 | |
| (630) 393-0499 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 28379 Davis Pkwy, Warrenville, Illinois |
| Authorized Official Name and Position | Martin Edward Lemon (OWNER) |
| Authorized Official Contact | 6303939800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
28379 Davis Pkwy Suite 801 Warrenville IL 60555-3032 Ph: (630) 393-9800 | 28379 Davis Pkwy Suite 801 Warrenville IL 60555-3032 Ph: (630) 393-9800 |
| NPI Number | 1487779468 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 10/06/2016 |
| Medicare PECOS PAC ID | 5395894778 |
|---|---|
| Medicare Enrollment ID | O20090513000505 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487779468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 071-004794 (Illinois) | Primary |
| Provider Name | Martin E Lemon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063650141 PECOS PAC ID: 4183773575 Enrollment ID: I20090513000576 |
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