Healthcare Provider Details

I. General information

NPI: 1760900799
Provider Name (Legal Business Name): ABRAHAM LUBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MADISON ST STE 300
OAK PARK IL
60302-4210
US

IV. Provider business mailing address

768 BILOXIE CT
CAROL STREAM IL
60188-9213
US

V. Phone/Fax

Practice location:
  • Phone: 708-486-2700
  • Fax:
Mailing address:
  • Phone: 630-946-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277003662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: