Healthcare Provider Details

I. General information

NPI: 1346401379
Provider Name (Legal Business Name): MELINDA KAY LUKENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST #1880
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

676 N SAINT CLAIR ST #1880
CHICAGO IL
60611-2927
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-9844
  • Fax: 312-642-7637
Mailing address:
  • Phone: 312-642-9844
  • Fax: 312-642-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036119626
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: