Healthcare Provider Details

I. General information

NPI: 1366494585
Provider Name (Legal Business Name): VIRGINIA P LUCES M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LARKIN AVE SUITE 101
ELGIN IL
60123-4405
US

IV. Provider business mailing address

2050 LARKIN AVE SUITE 101
ELGIN IL
60123-4405
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-9698
  • Fax: 847-742-9743
Mailing address:
  • Phone: 847-742-9698
  • Fax: 847-742-9743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number336026758
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-062230
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: