Provider Demographics
NPI:1639126212
Name:PIRACHA, LUBNA L (DO)
Entity Type:Individual
Prefix:
First Name:LUBNA
Middle Name:L
Last Name:PIRACHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 S CICERO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6459
Mailing Address - Country:US
Mailing Address - Phone:708-636-7575
Mailing Address - Fax:
Practice Address - Street 1:10837 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6458
Practice Address - Country:US
Practice Address - Phone:708-636-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094153207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00005624OtherRRMC-LOCALITY 15
ILP00005623OtherRRMC-LOCALITY 16
IL1316998578OtherNPI GROUP PRACTICE
IL1487951711OtherAMG/HAVI
ILL97358OtherMEDICARE PIN-LOCALITY 15
IL7404177OtherAETNA
IL1616378OtherBCBS
ILL97357OtherMEDICARE PIN-LOCALITY 16
ILH11603Medicare UPIN