Healthcare Provider Details

I. General information

NPI: 1407084635
Provider Name (Legal Business Name): LUKE MICHAEL LUETKEMEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 N ALLEN RD
PEORIA IL
61614-3294
US

IV. Provider business mailing address

6000 N ALLEN RD
PEORIA IL
61614-3294
US

V. Phone/Fax

Practice location:
  • Phone: 309-258-3174
  • Fax:
Mailing address:
  • Phone: 309-691-1400
  • Fax: 309-693-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036138951
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036138951
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: