Individual
DR. JONATHAN LUCKING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 333-3311
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801-0804
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036161715
IL
208600000X
Surgery Physician
25MA10294700
NJ
208600000X
Surgery Physician
ME141153
FL
208C00000X
Colon & Rectal Surgery Physician
ME141153
FL
Other
Enumeration date
05/29/2013
Last updated
12/22/2022
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