Healthcare Provider Details

I. General information

NPI: 1083769202
Provider Name (Legal Business Name): LUNA MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4397 N ELSTON AVE
CHICAGO IL
60641-2147
US

IV. Provider business mailing address

4397 N ELSTON AVE
CHICAGO IL
60641-2147
US

V. Phone/Fax

Practice location:
  • Phone: 800-380-4339
  • Fax: 888-696-0299
Mailing address:
  • Phone: 800-380-4339
  • Fax: 888-696-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203000472
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number203000472
License Number StateIL

VIII. Authorized Official

Name: MARIANNE HELEN LUH
Title or Position: FOUNDER
Credential:
Phone: 800-380-4339