MEDICARE: ALYSSA LUPTAK

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	363LF0000X	Family Nurse Practitioner	209.019335	IL

General Provider Information

NPI Number	:	1801450903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA LUPTAK

Provider Business Mailing Address
First Line	:	1 N WAUKEGAN RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-1802
Country	:	US
Telephone Number	:	847-936-5800
Fax Number	:	847-936-5824

Provider Business Practice Location Address
First Line	:	1 N WAUKEGAN RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-1802
Country	:	US
Telephone Number	:	847-936-5800
Fax Number	:	847-936-5824

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

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	02/09/2026

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