Provider Demographics
NPI:1336395524
Name:LUNA, CARLA J (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:LUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:1460 N HALSTED ST STE 506
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2615
Practice Address - Country:US
Practice Address - Phone:773-883-0274
Practice Address - Fax:773-883-0208
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.123632207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400726967OtherMEDICARE PTAN
ILF400726965OtherMEDICARE PTAN
IL036123632Medicaid