MEDICARE: C. LUCY PARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036069211	IL

General Provider Information

NPI Number	:	1609886183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C. LUCY PARK

Provider Business Mailing Address
First Line	:	606 FOREST RD
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-3448
Country	:	US
Telephone Number	:	312-203-5587
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S WILKE RD
Second Line	:	SUITE 311
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1533
Country	:	US
Telephone Number	:	630-599-5444
Fax Number	:	630-599-5445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	01/28/2012

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Directions to “ C. LUCY PARK ” Practice Location

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