Provider Demographics
NPI:1407848617
Name:LUECKING, JANE F (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:LUECKING
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 1:1790 NATIONS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9164
Mailing Address - Country:US
Mailing Address - Phone:847-244-9740
Mailing Address - Fax:847-244-9870
Practice Address - Street 1:1790 NATIONS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9164
Practice Address - Country:US
Practice Address - Phone:847-244-9740
Practice Address - Fax:847-244-9870
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR02237OtherMEDICARE PTAN
IL036090215Medicaid
WI35307300Medicaid
ILG13876Medicare UPIN
WI35307300Medicaid