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Search › Illinois › 106S00000X

Luchinni Prabowo-Mandayo

NPI 1801623152 · on the registry since 2024 · sole proprietor

Practice

Address
444 N Northwest Hwy Ste 147
Park Ridge, IL 60068
Phone
(847) 610-9798
Organisation at this address
Ridge Optical
Rainbow Hospice
North Park Clinic, S.C.
Diagnostic Neurology, Ltd
Indus Healthcare Staffing
Inferred from a shared address, not stated in the registry.
Clinicians at this address
99

Registry record

Primary taxonomy
106S00000X
106S00000X
Licence states on file
NULL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2024-09-18

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois