Provider Demographics
NPI:1720273311
Name:LUCAS, DOROTHY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:JEAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8346 S RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5705
Mailing Address - Country:US
Mailing Address - Phone:773-874-1776
Mailing Address - Fax:773-874-1456
Practice Address - Street 1:8346 S RHODES AVE
Practice Address - Street 2:65 EAST 75TH STREET
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5705
Practice Address - Country:US
Practice Address - Phone:773-874-1776
Practice Address - Fax:773-874-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14640Medicare UPIN