Provider Demographics
NPI:1679729511
Name:LUBAWSKI, JAMES L JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:LUBAWSKI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-8850
Mailing Address - Fax:630-933-8849
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-8850
Practice Address - Fax:630-933-8849
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124048208G00000X
IL125050690208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124048Medicaid
IL206147OtherMEDICARE (GROUP PTAN)
ILF400098894OtherMEDICARE (INDIVIDUAL PTAN)