Basic Information
Provider Information
NPI: 1255312971
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUKA
FirstName: SAMIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 379
Address2:  
City: ORLAND PARK
State: IL
PostalCode: 604620379
CountryCode: US
TelephoneNumber: 7084609836
FaxNumber: 7084601117
Practice Location
Address1: 1301 COPPERFIELD AVE
Address2: SUITE 116
City: JOLIET
State: IL
PostalCode: 604322054
CountryCode: US
TelephoneNumber: 8157221818
FaxNumber: 8157222533
Other Information
ProviderEnumerationDate: 11/09/2005
LastUpdateDate: 07/23/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001X036070047ILY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

ID Information
IDTypeStateIssuerDescription
03607004705IL MEDICAID
92000581201ILRR MEDICARE JOLIET RADOTHER
92000581301ILRR MEDICARE M&K RADOTHER


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