Provider Demographics
NPI:1356707111
Name:BAKMAN, LUBOV
Entity type:Individual
Prefix:
First Name:LUBOV
Middle Name:
Last Name:BAKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 IVY LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1086
Mailing Address - Country:US
Mailing Address - Phone:224-522-3040
Mailing Address - Fax:
Practice Address - Street 1:4860 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2953
Practice Address - Country:US
Practice Address - Phone:847-329-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-10
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013478363LF0000X, 364SF0001X
IL209.013478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health