Provider Demographics
NPI:1124228853
Name:KLEMINE, LUBOV A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUBOV
Middle Name:A
Last Name:KLEMINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5004
Mailing Address - Country:US
Mailing Address - Phone:773-395-8444
Mailing Address - Fax:773-395-8400
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-395-8444
Practice Address - Fax:773-395-8400
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105632Medicaid
ILK11452Medicare PIN
IL036105632Medicaid