Healthcare Provider Details

I. General information

NPI: 1992792253
Provider Name (Legal Business Name): GERALD LUGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE
MELROSE PARK IL
60160-1634
US

IV. Provider business mailing address

7607 W MADISON AVE
FOREST PARK IL
60130-3513
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-4557
  • Fax: 708-338-2000
Mailing address:
  • Phone: 708-366-7177
  • Fax: 708-366-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036064254
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036064254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: