Healthcare Provider Details

I. General information

NPI: 1083628853
Provider Name (Legal Business Name): YVONNE PATRICE LUCERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5TH AVENUE AT ROOSEVELT ROAD BLDG 128
HINES IL
60141
US

IV. Provider business mailing address

63 N DELAPLAINE RD
RIVERSIDE IL
60546-2058
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2241
  • Fax: 708-202-7960
Mailing address:
  • Phone: 708-202-2241
  • Fax: 708-202-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: