Provider Demographics
NPI:1578540522
Name:NELLIGAN, LUKE GERARD (DO)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:GERARD
Last Name:NELLIGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 BRENDON WAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1961
Mailing Address - Country:US
Mailing Address - Phone:317-733-8780
Mailing Address - Fax:866-246-1514
Practice Address - Street 1:1329 WEST 96TH STREET
Practice Address - Street 2:EXCELL FOR LIFE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-660-0888
Practice Address - Fax:317-660-0880
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001548207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000520470OtherANTHEM
IN000000632914OtherBC/BS PIKE MEDICAL
5428035OtherAETNA
IN100465550AMedicaid
IN15D1069058OtherCLIA
IN200856130Medicaid
768544OtherCIGNA
IN100465550AMedicaid
IN248600YMedicare PIN
768544OtherCIGNA