Healthcare Provider Details

I. General information

NPI: 1053051789
Provider Name (Legal Business Name): LUNA SAMER NASRY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SOUTH WOOD STREET SUITE 100, MC 675
CHICAGO IL
60612
US

IV. Provider business mailing address

820 SOUTH WOOD STREET SUITE 100, MC 675
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2933
  • Fax:
Mailing address:
  • Phone: 312-996-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036172398
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: