Provider Demographics
NPI:1821383209
Name:ERNSTBERGER, LUKE STEPHEN II (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:STEPHEN
Last Name:ERNSTBERGER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9428 HADDINGTON DR W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 N CELIA AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4609
Practice Address - Country:US
Practice Address - Phone:765-747-4454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11016178A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01378362OtherRAIL ROAD MEDICARE PIN
IN201095550Medicaid
INM22404025Medicare PIN
IN256480035Medicare PIN
INP01378362OtherRAIL ROAD MEDICARE PIN