MEDICARE: DR. DAVID GENE LUKENS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01031925	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00128646	OTHER	IN	RRMEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000312424	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1407805641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GENE LUKENS M.D.

Provider Business Mailing Address
First Line	:	1201 N POST RD
Second Line	:	SUITE 4
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4246
Country	:	US
Telephone Number	:	317-355-5250
Fax Number	:	317-355-9663

Provider Business Practice Location Address
First Line	:	1201 N POST RD
Second Line	:	SUITE 4
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4246
Country	:	US
Telephone Number	:	317-355-5250
Fax Number	:	317-355-9663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	11/19/2007

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