Healthcare Provider Details

I. General information

NPI: 1619554672
Provider Name (Legal Business Name): LUKE ANTHONY HORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16105 S LA GRANGE RD
ORLAND PARK IL
60467-5503
US

IV. Provider business mailing address

38W335 CHRISTINA CT
BATAVIA IL
60510-9528
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-3767
  • Fax:
Mailing address:
  • Phone: 630-862-8862
  • Fax: 630-761-8724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number94265
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: