Provider Demographics
NPI:1023339793
Name:LUZANO, MARIA CONSUELO BARBA (PT)
Entity type:Individual
Prefix:
First Name:MARIA CONSUELO
Middle Name:BARBA
Last Name:LUZANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 KETTERING RD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-5364
Mailing Address - Country:US
Mailing Address - Phone:847-566-2106
Mailing Address - Fax:
Practice Address - Street 1:1501 BUSCH PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2686
Practice Address - Country:US
Practice Address - Phone:847-419-7150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005896283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital