Healthcare Provider Details

I. General information

NPI: 1962211391
Provider Name (Legal Business Name): MICHAEL LU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 L ST
ANCHORAGE AK
99501-1959
US

IV. Provider business mailing address

510 L ST
ANCHORAGE AK
99501-1959
US

V. Phone/Fax

Practice location:
  • Phone: 847-238-6567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number244547
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: