Provider Demographics
NPI:1083679286
Name:LUKE, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:LUKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 GREAT RD
Mailing Address - Street 2:UNIT 205
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6833
Mailing Address - Country:US
Mailing Address - Phone:401-766-4304
Mailing Address - Fax:401-762-5107
Practice Address - Street 1:501 GREAT RD
Practice Address - Street 2:UNIT 205
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6833
Practice Address - Country:US
Practice Address - Phone:401-766-4304
Practice Address - Fax:401-762-5107
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD06575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000307Medicaid
RI029000307Medicare PIN
RIC90369Medicare UPIN
RI9000307Medicaid