Provider Demographics
NPI:1700848611
Name:LUCHTEFELD, WILLIAM BRIAN (NP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRIAN
Last Name:LUCHTEFELD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 GILBERT LN
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5504
Mailing Address - Country:US
Mailing Address - Phone:618-465-7470
Mailing Address - Fax:314-868-2561
Practice Address - Street 1:10600 LEWIS AND CLARK BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6005
Practice Address - Country:US
Practice Address - Phone:314-286-6988
Practice Address - Fax:314-868-2561
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101018363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health