Healthcare Provider Details

I. General information

NPI: 1578540522
Provider Name (Legal Business Name): LUKE GERARD NELLIGAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 WEST 96TH STREET EXCELL FOR LIFE
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

55 BRENDON WAY SUITE 800
ZIONSVILLE IN
46077-1961
US

V. Phone/Fax

Practice location:
  • Phone: 317-660-0888
  • Fax: 317-660-0880
Mailing address:
  • Phone: 317-733-8780
  • Fax: 866-246-1514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001548
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: