Provider Demographics
NPI:1366647117
Name:LUKAT, KIMBERLY MICHELE (LM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:LUKAT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:LUKAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM
Mailing Address - Street 1:2904 SW MARIPOSA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990
Mailing Address - Country:US
Mailing Address - Phone:772-781-3830
Mailing Address - Fax:772-781-3830
Practice Address - Street 1:2904 SW MARIPOSA CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-6058
Practice Address - Country:US
Practice Address - Phone:772-781-3830
Practice Address - Fax:772-781-3830
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 187176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife