Individual
JACOB STUART JOSEPH LUCERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2450 BUCKLEY RD, NORTH CHICAGO, IL 60064-3092
(847) 688-1900
Mailing address
855 SANCTUARY DR APT 303A, LAKE VILLA, IL 60046-7988
(719) 271-3871
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
590484
—
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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