Provider Demographics
NPI:1083769202
Name:LUNA MEDICAL INC.
Entity Type:Organization
Organization Name:LUNA MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:LUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-380-4339
Mailing Address - Street 1:1057 W GRAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6600
Mailing Address - Country:US
Mailing Address - Phone:800-380-4339
Mailing Address - Fax:888-696-0299
Practice Address - Street 1:1057 W GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6600
Practice Address - Country:US
Practice Address - Phone:800-380-4339
Practice Address - Fax:888-696-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000472332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623767OtherBCBS IL
IL1024415OtherUHC
IL01623767OtherBCBS IL