Provider Demographics
NPI:1376797308
Name:LU, MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:
Last Name:LU
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 1:316 CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1610
Mailing Address - Country:US
Mailing Address - Phone:708-366-0145
Mailing Address - Fax:630-279-3527
Practice Address - Street 1:1S045 SPRING RD
Practice Address - Street 2:#3E
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4667
Practice Address - Country:US
Practice Address - Phone:630-279-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054473172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL641850Medicare UPIN