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General NPI Number Information
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NPI Number | 1316070931
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Entity Type | Individual
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Provider Name | ADELE LUCI DANNY D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 142 INDIAN SPRINGS DR MEDICINE SHOPPE PHARMACY CORNER CARE CLINIC
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City | SANDWICH
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State | IL
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Zip | 60548-1902
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Country | US
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Telephone | 815-786-8696
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7675
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City | GURNEE
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State | IL
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Zip | 60031-7002
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Country | US
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Telephone | 847-404-8729
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Fax | 847-549-8415
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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