Provider Demographics
NPI:1134374291
Name:LUCK, JOY (NP)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3673
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-3673
Mailing Address - Country:US
Mailing Address - Phone:734-973-0710
Mailing Address - Fax:734-973-2428
Practice Address - Street 1:2009 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4010
Practice Address - Country:US
Practice Address - Phone:517-784-1700
Practice Address - Fax:517-784-2441
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704181507207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology