Provider Demographics
NPI:1366494585
Name:LUCES, VIRGINIA P (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:P
Last Name:LUCES
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 1:2050 LARKIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4405
Mailing Address - Country:US
Mailing Address - Phone:847-742-9698
Mailing Address - Fax:847-742-9743
Practice Address - Street 1:2050 LARKIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4405
Practice Address - Country:US
Practice Address - Phone:847-742-9698
Practice Address - Fax:847-742-9743
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336026758208000000X
IL036-062230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1366494585OtherBCBSWI
IL036062230Medicaid
WILUCESVIROtherMERCYCARE INSURANCE
WI1366494585OtherBCBSWI
WILUCESVIROtherMERCYCARE INSURANCE
IL795140006Medicare PIN