| Martie Ryan Lukanich Psy D Pc | |
|
9631 W 153rd St Ste 37 Orland Park IL 60462-3778 | |
| (708) 829-8277 | |
| Not Available |
| Full Name | Martie Ryan Lukanich Psy D Pc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 9631 W 153rd St Ste 37, Orland Park, Illinois |
| Authorized Official Name and Position | Martie Ryan Lukanich (PRESIDENT) |
| Authorized Official Contact | 7088298277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martie Ryan Lukanich Psy D Pc 521 Bell Ave La Grange IL 60525-5903 Ph: (708) 829-8277 | Martie Ryan Lukanich Psy D Pc 9631 W 153rd St Ste 37 Orland Park IL 60462-3778 Ph: (708) 829-8277 |
| NPI Number | 1508535618 |
|---|---|
| Provider Enumeration Date | 09/10/2021 |
| Last Update Date | 09/10/2021 |
| Certification Date | 09/10/2021 |
| Medicare PECOS PAC ID | 1456758283 |
|---|---|
| Medicare Enrollment ID | O20210922000289 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508535618 | NPI | - | NPPES |
| 1497886196 | Other | NPI | |
| 1740403476 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Martie Ryan Lukanich |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497886196 PECOS PAC ID: 2365849197 Enrollment ID: I20210922000322 |
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