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NPI Code Detail

MEDICARE: MR. WILLIAM BRIAN LUCHTEFELD NP

MEDICARE: MR. WILLIAM BRIAN LUCHTEFELD NP
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
1363LA2200XAdult Health Nurse Practitioner101018MO

General Provider Information

NPI Number : 1700848611
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM BRIAN LUCHTEFELD NP
Provider Business Mailing Address
First Line : 2910 GILBERT LN
Second Line :
City : ALTON
State : IL
Zip : 62002-5504
Country : US
Telephone Number : 618-465-7470
Fax Number : 314-868-2561
Provider Business Practice Location Address
First Line : 10600 LEWIS AND CLARK BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-6005
Country : US
Telephone Number : 314-286-6988
Fax Number : 314-868-2561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 01/16/2008

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