Provider Demographics
NPI:1740686492
Name:MOSHKOVICH, LANA (LAC)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:MOSHKOVICH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 TAMER LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3768
Mailing Address - Country:US
Mailing Address - Phone:847-508-1470
Mailing Address - Fax:
Practice Address - Street 1:1500 SHERMER RD STE LL29
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-715-9044
Practice Address - Fax:847-564-2100
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001239171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL198001239OtherLICENSE