Provider Demographics
NPI:1437125846
Name:LUKE, TIMOTHY A (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:LUKE
Suffix:
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 1:8805 N 23RD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4149
Mailing Address - Country:US
Mailing Address - Phone:602-265-8800
Mailing Address - Fax:602-258-4371
Practice Address - Street 1:8805 N 23RD AVE STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4149
Practice Address - Country:US
Practice Address - Phone:602-265-8800
Practice Address - Fax:602-258-4371
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41183207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8490436Medicaid
CA00A894510Medicare ID - Type Unspecified
CAI18856Medicare UPIN