MEDICARE: DR. DOROTHY JEAN LUCAS MD

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	207VG0400X	Gynecology Physician		IL

General Provider Information

NPI Number	:	1720273311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY JEAN LUCAS MD

Provider Business Mailing Address
First Line	:	8346 S RHODES AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-5705
Country	:	US
Telephone Number	:	773-874-1776
Fax Number	:	773-874-1456

Provider Business Practice Location Address
First Line	:	8346 S RHODES AVE
Second Line	:	65 EAST 75TH STREET
City	:	CHICAGO
State	:	IL
Zip	:	60619-5705
Country	:	US
Telephone Number	:	773-874-1776
Fax Number	:	773-874-1456

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

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	09/07/2007

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