Provider Demographics
NPI:1790233690
Name:DR. LULJETA JUSUFI D.D.S.,LTD
Entity Type:Organization
Organization Name:DR. LULJETA JUSUFI D.D.S.,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LULJETA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSUFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-755-4000
Mailing Address - Street 1:3166 N LINCOLN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3133
Mailing Address - Country:US
Mailing Address - Phone:773-755-4000
Mailing Address - Fax:773-755-4431
Practice Address - Street 1:3166 N LINCOLN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3133
Practice Address - Country:US
Practice Address - Phone:773-755-4000
Practice Address - Fax:773-755-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190248311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL102271Medicaid