Healthcare Provider Details

I. General information

NPI: 1487736450
Provider Name (Legal Business Name): RONALD LUCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MAXINE DR
MORTON IL
61550-2498
US

IV. Provider business mailing address

435 MAXINE DR
MORTON IL
61550-2498
US

V. Phone/Fax

Practice location:
  • Phone: 309-263-2424
  • Fax: 309-284-2255
Mailing address:
  • Phone: 309-263-2424
  • Fax: 309-284-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: