Individual
DR. LUVIANCA J. FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4255 W 63RD ST, CHICAGO, IL 60629-5041
(773) 424-4048
(773) 424-6463
Mailing address
4255 W 63RD ST, CHICAGO, IL 60629-5041
(773) 424-4048
(773) 424-6463
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036105462
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105462
—
IL
Enumeration date
10/11/2005
Last updated
12/28/2021
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