Provider Demographics
NPI:1609224559
Name:LU, SKYE (DO)
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1282
Mailing Address - Country:US
Mailing Address - Phone:269-337-6019
Mailing Address - Fax:
Practice Address - Street 1:325 CHARLES H DIMMOCK PKWY STE 600
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2988
Practice Address - Country:US
Practice Address - Phone:804-518-3288
Practice Address - Fax:888-990-1241
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205670208000000X
MI5151011570390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program