Provider Demographics
NPI:1831115229
Name:LUFT, ULRICH C (MD)
Entity Type:Individual
Prefix:
First Name:ULRICH
Middle Name:C
Last Name:LUFT
Suffix:
Gender:M
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 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:100 SPALDING DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6550
Practice Address - Country:US
Practice Address - Phone:630-435-6100
Practice Address - Fax:630-435-6110
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045107207R00000X
NJ25MA08868100207RC0000X
ORMD24558207R00000X
CAA79849207RC0000X
AZ41394207RC0000X
IL036142263207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8427551Medicaid
IL036142263Medicaid
WA0198083OtherL&I
AZ395551Medicaid
AZZ128483Medicare PIN
WA8854887Medicare ID - Type Unspecified