Healthcare Provider Details

I. General information

NPI: 1144396607
Provider Name (Legal Business Name): LUKE JOHN MCCANN D.P.M., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 12/17/2021
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR BLVD KAISER PERMANENTE OAKLAND MEDICAL CENTER
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

311 2ND ST UNIT 604
OAKLAND CA
94607-4164
US

V. Phone/Fax

Practice location:
  • Phone: 925-324-8753
  • Fax:
Mailing address:
  • Phone: 925-324-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32830
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: