Healthcare Provider Details

I. General information

NPI: 1861377681
Provider Name (Legal Business Name): LUCAS CHESKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WABASH AVE
SPRINGFIELD IL
62704-5352
US

IV. Provider business mailing address

PO BOX 19273
SPRINGFIELD IL
62794-9273
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209032748
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: