Active NPI
Lubow Olga Lewicky, MD
- Obstetrics & Gynecology Physician
- Kankakee, IL
National Provider Identifier
1124013685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 036095446
- Practice address
- 375 N Wall St
Suite P410
Kankakee, IL 60901-3483 - Phone
- (815) 932-7474
- Fax
- (815) 937-8206
- NPI assigned
- Sep 12, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 036095446 | IL | Primary |
Addresses
Primary practice location
375 N Wall St
Suite P410
Kankakee, IL 60901-3483
Mailing address
375 N Wall St
Suite P410
Kankakee, IL 60901-3483
Phone (815) 932-7474
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036095446 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1124013685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 N WALL ST",
"address_2": "SUITE P410",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609013483",
"telephone_number": "815-932-7474",
"fax_number": "815-937-8206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 N WALL ST",
"address_2": "SUITE P410",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609013483",
"telephone_number": "815-932-7474",
"fax_number": "815-937-8206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWICKY",
"first_name": "LUBOW",
"middle_name": "OLGA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-12",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "IL",
"license": "036095446",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036095446",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.