Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 36106073 | IL |
N | 208600000X | Surgeon | 36106073 | IL |
Y | 2086S0102X | Surgical Critical Care | 36106073 | IL |
N | 2086S0127X | Trauma Surgeon | 36106073 | IL |
NPI | 1285600528 |
---|---|
Provider Name | Frederick Luchette |
First Address | Maywood, IL 60153 |
Second Address | Maywood, IL 60153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 19/04/2021 |