Individual
TAYLOR MITCHELL LUKETIC I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.A
Contact information
Practice address
310 N LOOMIS ST, CHICAGO, IL 60607-1147
(312) 733-0883
Mailing address
310 N LOOMIS ST, CHICAGO, IL 60607-1147
(312) 733-0883
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
793622893
CIGNA
IL
01
—
QMG825631865
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/03/2017
Last updated
02/03/2017
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