Provider Demographics
NPI:1902968050
Name:LUPU, JANICE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:LUPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 LEE ST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4539
Mailing Address - Country:US
Mailing Address - Phone:847-827-3008
Mailing Address - Fax:847-827-3802
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-677-4200
Practice Address - Fax:847-677-4209
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036062068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42508Medicare UPIN
ILP07400Medicare PIN
IL110046647Medicare PIN