Healthcare Provider Details

I. General information

NPI: 1073975181
Provider Name (Legal Business Name): KRISTIN LUCAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN LITTLE

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W 155TH ST
HARVEY IL
60426-3556
US

IV. Provider business mailing address

31 W 155TH ST
HARVEY IL
60426-3556
US

V. Phone/Fax

Practice location:
  • Phone: 708-596-5177
  • Fax: 708-596-5518
Mailing address:
  • Phone: 708-596-5177
  • Fax: 708-596-5518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.068797
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036151537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: