Provider Demographics
NPI:1013982891
Name:LUK, SAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:LUK
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 1:3743 S ATLANTIC AVE
Mailing Address - Street 2:#3C
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-7256
Mailing Address - Country:US
Mailing Address - Phone:386-767-7570
Mailing Address - Fax:
Practice Address - Street 1:17580 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6711
Practice Address - Country:US
Practice Address - Phone:352-383-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0066291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255452600Medicaid
FL44548AMedicare ID - Type Unspecified
FLGH2214Medicare UPIN