MEDICARE: STEPHANIE L LUTHER M.D.

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	208000000X	Pediatrics Physician	036-099934	IL
2	207R00000X	Internal Medicine Physician	036-099934	IL

General Provider Information

NPI Number	:	1134196231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE L LUTHER M.D.

Provider Business Mailing Address
First Line	:	1015 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5017
Country	:	US
Telephone Number	:	773-751-1859
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5017
Country	:	US
Telephone Number	:	773-751-1859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	08/08/2011

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