Provider Demographics
NPI:1356343321
Name:LUK, TIM T (DO)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:T
Last Name:LUK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3998 FAIR RIDGE DR
Mailing Address - Street 2:STE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-293-9590
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:3 ERIE CT
Practice Address - Street 2:WEST SUBURBAN MEDICAL CENTER
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2519
Practice Address - Country:US
Practice Address - Phone:708-783-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2015-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036082926207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7200007Medicare PIN
ILE93819Medicare UPIN