Provider Demographics
NPI:1902360126
Name:LUCHOW, MICHAELA M
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:M
Last Name:LUCHOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12310 WINDCLIFF
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-1677
Mailing Address - Country:US
Mailing Address - Phone:248-892-5951
Mailing Address - Fax:
Practice Address - Street 1:223 KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-5400
Practice Address - Country:US
Practice Address - Phone:248-892-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer