Provider Demographics
NPI:1073084398
Name:LELA IDUNA,P.C.
Entity Type:Organization
Organization Name:LELA IDUNA,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LELA
Authorized Official - Middle Name:
Authorized Official - Last Name:IDUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-666-5062
Mailing Address - Street 1:1222 GERRY ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3614
Mailing Address - Country:US
Mailing Address - Phone:510-666-5062
Mailing Address - Fax:
Practice Address - Street 1:110 S JOHNSON ST STE 206
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3259
Practice Address - Country:US
Practice Address - Phone:815-355-1605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center