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General NPI Number Information
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NPI Number | 1376833657
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Entity Type | Individual
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Provider Name | BRIAN JOSEPH LUC M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 3348 W 87TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-3767
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Country | US
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Telephone | 773-776-4471
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Fax | 773-564-3510
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 773-352-1515
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Fax | 312-929-0373
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036135556
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License Number State | IL
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