Provider Demographics
NPI:1760429146
Name:LUTCHKA, DARLENE S (MD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:S
Last Name:LUTCHKA
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:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:618-985-6860
Practice Address - Street 1:400 S LEWIS LANE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1409
Practice Address - Country:US
Practice Address - Phone:618-519-9900
Practice Address - Fax:518-519-9901
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112428Medicaid
IL370966854017Medicaid
ILCF3444OtherMEDICARE RAILROAD GROUP
IL141970Medicare Oscar/Certification
IL370966854017Medicaid
ILCF3444OtherMEDICARE RAILROAD GROUP
IL640701Medicare Oscar/Certification
ILK20627Medicare PIN
IL640702Medicare Oscar/Certification