Provider Demographics
NPI:1073542932
Name:LUTHER, KIRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:LUTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COULTER ROAD
Mailing Address - Street 2:ATTN MEDICAL STAFF OFFICE
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432
Mailing Address - Country:US
Mailing Address - Phone:315-462-0191
Mailing Address - Fax:315-462-2487
Practice Address - Street 1:2 COULTER ROAD
Practice Address - Street 2:HEALTH FIRST FAMILY PRACTICE
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432
Practice Address - Country:US
Practice Address - Phone:315-462-1467
Practice Address - Fax:315-462-6636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00391963OtherRAILROAD MEDICARE
NY01639427Medicaid
P020200981OtherROCHESTER BLUE SHIELD
NY1832748FOtherPREFERRED CARE
NY1639427Medicaid
NY2009819BOtherWORKERS COMPENSATION
183274BFOtherPREFERRED CARE
NYP010200981OtherBLUE CHOICE
NYDF7757OtherRAILROAD MEDICARE
P010200981OtherBLUE CHOICE
P010200981OtherBLUE CHOICE
NY1832748FOtherPREFERRED CARE