Provider Demographics
NPI:1215969308
Name:LU, EVAN (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 N MICHIGAN AVE STE 1086
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4521
Mailing Address - Country:US
Mailing Address - Phone:312-312-3650
Mailing Address - Fax:312-312-3653
Practice Address - Street 1:980 N MICHIGAN AVE STE 1086
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4521
Practice Address - Country:US
Practice Address - Phone:312-312-3650
Practice Address - Fax:312-312-3653
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G75757Medicare UPIN