Provider Demographics
NPI:1073590337
Name:LU, JIM ZB (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:ZB
Last Name:LU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4501
Mailing Address - Country:US
Mailing Address - Phone:224-588-9940
Mailing Address - Fax:224-588-9941
Practice Address - Street 1:1000 CORPORATE GROVE DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4550
Practice Address - Country:US
Practice Address - Phone:224-588-9940
Practice Address - Fax:224-588-9941
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39675207ZP0101X
IN01059594A207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200495730AMedicaid
IL036119395Medicaid
KS30004059010001Medicaid
IN000000340880OtherANTHEM
679170PPMedicare ID - Type Unspecified