Provider Demographics
NPI:1861494627
Name:PHILIPPSEN, LUKE PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:PATRICK
Last Name:PHILIPPSEN
Suffix:
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE
Practice Address - Street 2:STE 501
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3434
Practice Address - Country:US
Practice Address - Phone:765-284-2172
Practice Address - Fax:765-288-1292
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031105A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100088430Medicaid
INB28725Medicare UPIN
IN208340CMedicare PIN
IN100088430Medicaid