Provider Demographics
NPI:1720578685
Name:BIBEAU, LUC (DPM)
Entity Type:Individual
Prefix:DR
First Name:LUC
Middle Name:
Last Name:BIBEAU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 WARD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1300
Mailing Address - Country:US
Mailing Address - Phone:720-390-5299
Mailing Address - Fax:203-685-1757
Practice Address - Street 1:5730 WARD RD STE 202
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1300
Practice Address - Country:US
Practice Address - Phone:720-390-5299
Practice Address - Fax:203-685-1757
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000933213ES0103X
KY269120213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPOD.0000933OtherMEDICAL LICENSE
IN07001367AOtherMEDICAL LICENSE