Provider Demographics
NPI:1710641121
Name:KIDD, LUKE ROBERT
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:ROBERT
Last Name:KIDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 YARROWDALE DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2422
Mailing Address - Country:US
Mailing Address - Phone:330-800-7556
Mailing Address - Fax:
Practice Address - Street 1:109 YARROWDALE DR
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-2422
Practice Address - Country:US
Practice Address - Phone:330-800-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide