Provider Demographics
NPI:1497773006
Name:LINCONA MEDICAL ASSO.LTD.
Entity Type:Organization
Organization Name:LINCONA MEDICAL ASSO.LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIBOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-878-1515
Mailing Address - Street 1:5131 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2585
Mailing Address - Country:US
Mailing Address - Phone:773-878-1515
Mailing Address - Fax:
Practice Address - Street 1:5131 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2585
Practice Address - Country:US
Practice Address - Phone:773-878-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH75039Medicare UPIN