Provider Demographics
NPI:1194040576
Name:ROSEN, LUKE BILLMEYER (DO)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:BILLMEYER
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1174 ALTURAS DR UNIT 4B
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-8341
Mailing Address - Country:US
Mailing Address - Phone:360-828-8130
Mailing Address - Fax:360-785-2171
Practice Address - Street 1:1174 ALTURAS DR UNIT 4B
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-8341
Practice Address - Country:US
Practice Address - Phone:360-828-8130
Practice Address - Fax:360-785-2171
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-17332084P0800X, 2083A0300X
WAOP604478772083A0300X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2109320Medicaid
WAG8938056Medicare UPIN