Provider Demographics
NPI:1891081758
Name:DEROO, LUKE ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:ALAN
Last Name:DEROO
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:2093 HEALTH DR SW STE 302
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9691
Practice Address - Country:US
Practice Address - Phone:616-252-5775
Practice Address - Fax:616-252-5785
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019255207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16078398Medicaid