Provider Demographics
NPI:1508992470
Name:BOLEK, LUKE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:
Last Name:BOLEK
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:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8932 SW 97H AVE
Practice Address - Street 2:SOUTH WING
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1936
Practice Address - Country:US
Practice Address - Phone:305-243-5512
Practice Address - Fax:305-243-4613
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98885207U00000X, 2085R0202X
IA36497207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314542Medicaid
FL279088200Medicaid