Provider Demographics
NPI:1326013392
Name:LUKEN, MARTIN G III (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:G
Last Name:LUKEN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W 156TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4260
Mailing Address - Country:US
Mailing Address - Phone:708-596-3344
Mailing Address - Fax:
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-596-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051447207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001629760OtherBCBS
IL0360514473Medicaid
ILP00760032OtherRR MEDICARE
IL0360514473Medicaid
D13438Medicare UPIN
ILL56253Medicare ID - Type Unspecified