Provider Demographics
NPI:1215010251
Name:LUKBAN, WILFREDO SIY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:SIY
Last Name:LUKBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:501 N LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1114
Mailing Address - Country:US
Mailing Address - Phone:610-284-8100
Mailing Address - Fax:610-284-8993
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-284-8100
Practice Address - Fax:610-284-8993
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063487-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine