Provider Demographics
NPI:1063492247
Name:LUY, ENRIQUE W (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:W
Last Name:LUY
Suffix:
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 1:6165 PRESTON LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-8787
Mailing Address - Country:US
Mailing Address - Phone:414-525-0221
Mailing Address - Fax:
Practice Address - Street 1:6165 PRESTON LN
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-8787
Practice Address - Country:US
Practice Address - Phone:414-525-0221
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20305-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB54707Medicare UPIN