Healthcare Provider Details

I. General information

NPI: 1497773006
Provider Name (Legal Business Name): LINCONA MEDICAL ASSO.LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 N LINCOLN AVE
CHICAGO IL
60625-2585
US

IV. Provider business mailing address

5131 N LINCOLN AVE
CHICAGO IL
60625-2585
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-1515
  • Fax:
Mailing address:
  • Phone: 773-878-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. GALINA GRIBOVICH
Title or Position: FAMILY PRACTICE
Credential: M.D
Phone: 773-878-1515