Provider Demographics
NPI:1679600779
Name:DOUGLAS K LUKE MD INC
Entity Type:Organization
Organization Name:DOUGLAS K LUKE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-791-3024
Mailing Address - Street 1:1424 OAK HILL WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4015
Mailing Address - Country:US
Mailing Address - Phone:916-791-3024
Mailing Address - Fax:
Practice Address - Street 1:1424 OAK HILL WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4015
Practice Address - Country:US
Practice Address - Phone:916-791-3024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16645207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G166450Medicaid
CA00G166450Medicare ID - Type Unspecified
CA00G166450Medicaid