Provider Demographics
NPI:1861441685
Name:LUMINATI, EDWARD J (PA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:LUMINATI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:730 CHEYENNE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-2423
Mailing Address - Country:US
Mailing Address - Phone:719-632-0324
Mailing Address - Fax:719-632-0326
Practice Address - Street 1:730 CHEYENNE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-2423
Practice Address - Country:US
Practice Address - Phone:719-632-0324
Practice Address - Fax:719-632-0326
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO808623Medicare PIN
COQ47705Medicare UPIN