Healthcare Provider Details

I. General information

NPI: 1659370062
Provider Name (Legal Business Name): DANIEL LOUIS LUETKEHANS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HIGHLAND AVE SUITE 301, TOWER 2
DOWNERS GROVE IL
60515-1552
US

IV. Provider business mailing address

1510 CADET CT
WHEATON IL
60189-7380
US

V. Phone/Fax

Practice location:
  • Phone: 630-434-0098
  • Fax:
Mailing address:
  • Phone: 630-221-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004128
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000739A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: