Individual
MARISA LUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(888) 584-7888
Mailing address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
125.081766
IL
207R00000X
Internal Medicine Physician
125.081766
IL
Other
Enumeration date
03/21/2023
Last updated
05/22/2024
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