Provider Demographics
NPI:1770274151
Name:DECKERT, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:DECKERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CLARK POINT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-4414
Mailing Address - Country:US
Mailing Address - Phone:207-244-4678
Mailing Address - Fax:207-244-4613
Practice Address - Street 1:184 CLARK POINT RD
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4414
Practice Address - Country:US
Practice Address - Phone:207-244-4678
Practice Address - Fax:207-244-4613
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEE3270814146N00000X
1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic