MEDICARE: LUNA MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	203000472	IL
2	332B00000X	Durable Medical Equipment & Medical Supplies	203000472	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01623767	OTHER	IL	BCBS IL
2	1024415	OTHER	IL	UHC

General Provider Information

NPI Number	:	1083769202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA MEDICAL, INC.

Provider Business Mailing Address
First Line	:	4397 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2147
Country	:	US
Telephone Number	:	800-380-4339
Fax Number	:	888-696-0299

Provider Business Practice Location Address
First Line	:	4397 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2147
Country	:	US
Telephone Number	:	800-380-4339
Fax Number	:	888-696-0299

Authorized Official
Title or Position	:	FOUNDER
Name	:	MARIANNE HELEN LUH
Credential	:
Telephone Number	:	800-380-4339

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	02/11/2025

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