Healthcare Provider Details

I. General information

NPI: 1346219706
Provider Name (Legal Business Name): ENRIQUE LUKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PLAZA DR LEHIGH ACRES
LEHIGH ACRES FL
33936-6018
US

IV. Provider business mailing address

222 PLAZA DR OKEECHOBEE
LEHIGH ACRES FL
33936-6018
US

V. Phone/Fax

Practice location:
  • Phone: 239-368-5437
  • Fax: 239-369-0880
Mailing address:
  • Phone: 239-368-5437
  • Fax: 239-369-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME65236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: