Provider Demographics
NPI:1275567240
Name:LUCKEYDOO, AMY K (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:LUCKEYDOO
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 1:1264 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-7100
Mailing Address - Country:US
Mailing Address - Phone:740-779-6805
Mailing Address - Fax:740-779-9116
Practice Address - Street 1:1264 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7100
Practice Address - Country:US
Practice Address - Phone:740-779-6805
Practice Address - Fax:740-779-9116
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.085066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2532790Medicaid