Healthcare Provider Details

I. General information

NPI: 1568396471
Provider Name (Legal Business Name): LYDIA E MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

IV. Provider business mailing address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

V. Phone/Fax

Practice location:
  • Phone: 888-991-9825
  • Fax:
Mailing address:
  • Phone: 888-991-9825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberIL-21035-170437
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: