Provider Demographics
NPI:1982858312
Name:WILDER, LUKE JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:JUSTIN
Last Name:WILDER
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 1:4057 MOONCOIN WAY
Mailing Address - Street 2:APT 10201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6088
Mailing Address - Country:US
Mailing Address - Phone:859-230-6077
Mailing Address - Fax:
Practice Address - Street 1:4057 MOONCOIN WAY
Practice Address - Street 2:APT 10201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6088
Practice Address - Country:US
Practice Address - Phone:859-230-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44339207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine