Healthcare Provider Details

I. General information

NPI: 1235711730
Provider Name (Legal Business Name): ABDUL-KAREEM OPEOLUWA LUKAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date: 04/11/2022
Reactivation Date: 05/05/2022

III. Provider practice location address

3134 N CLARKE ST.
CHICAGO IL
60657
US

IV. Provider business mailing address

3134 N CLARKE ST.
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-4949
  • Fax:
Mailing address:
  • Phone: 312-766-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number125078206
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: