Provider Demographics
NPI:1518223882
Name:MIDLO, LUKE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:DAVID
Last Name:MIDLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 E SUPERIOR ST
Mailing Address - Street 2:STE. L401
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2207
Mailing Address - Country:US
Mailing Address - Phone:218-249-7960
Mailing Address - Fax:218-249-7997
Practice Address - Street 1:1001 E SUPERIOR ST
Practice Address - Street 2:STE. L401
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2207
Practice Address - Country:US
Practice Address - Phone:218-249-7960
Practice Address - Fax:218-249-7997
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN59494207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program