Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036-119916 | IL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 336081139 | IL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 336081139 | IL |
NPI | 1205001187 |
---|---|
Provider Name | Lucy Munoz Medina |
First Address | Chicago, IL 60612-3714 |
Second Address | Chicago, IL 60612-4325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2008 |
Last Update Date | 27/04/2021 |