Provider Demographics
NPI:1326080656
Name:LUCHT, KAMILLA L (MD)
Entity Type:Individual
Prefix:
First Name:KAMILLA
Middle Name:L
Last Name:LUCHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMILLA
Other - Middle Name:L
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3602
Mailing Address - Country:US
Mailing Address - Phone:701-234-3600
Mailing Address - Fax:701-234-3515
Practice Address - Street 1:2701 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3602
Practice Address - Country:US
Practice Address - Phone:701-234-3600
Practice Address - Fax:701-234-3515
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1185208000000X
ND10224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN712019Medicare PIN