Individual
MRS. KELLY ANN LUCIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
520 N 4TH ST, SPRINGFIELD, IL 62702-5238
(217) 757-8100
Mailing address
817 E COOK ST, SPRINGFIELD, IL 62703-1625
(217) 816-6854
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
125.061583
IL
Other
Enumeration date
07/10/2012
Last updated
07/10/2012
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