Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036-131946 | IL |
Y | 207Q00000X | Family Doctor | 125-058819 | IL |
NPI | 1003132002 |
---|---|
Provider Name | Maximiliano Luna JR. |
First Address | Chicago, IL 60608-2486 |
Second Address | Chicago, IL 60608-2486 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 29/09/2020 |