Healthcare Provider Details

I. General information

NPI: 1750381729
Provider Name (Legal Business Name): LUCIE M BIANCHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 ROYAL BLVD SUITE 300
ELGIN IL
60123-4719
US

IV. Provider business mailing address

2350 ROYAL BLVD SUITE 300
ELGIN IL
60123-4719
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-3120
  • Fax: 847-742-4021
Mailing address:
  • Phone: 847-742-3120
  • Fax: 847-742-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036103332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: