Provider Demographics
NPI:1003174848
Name:LUCKOWER, PETER MARC (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MARC
Last Name:LUCKOWER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:MARC
Other - Last Name:LUCKOWER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:11111 BISCAYNE BLVD
Mailing Address - Street 2:STE 557
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3404
Mailing Address - Country:US
Mailing Address - Phone:305-893-0111
Mailing Address - Fax:305-893-0111
Practice Address - Street 1:11111 BISCAYNE BLVD
Practice Address - Street 2:STE 557
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3404
Practice Address - Country:US
Practice Address - Phone:305-893-0111
Practice Address - Fax:305-893-0111
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL779213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine