Provider Demographics
NPI:1487031407
Name:GLEASON, LUCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:
Last Name:GLEASON
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 1:1000 REMINGTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:1150 W FULLERTON AVE
Practice Address - Street 2:FLOOR 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-549-7757
Practice Address - Fax:773-549-1221
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067787390200000X
IL036146576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program