Healthcare Provider Details

I. General information

NPI: 1255750584
Provider Name (Legal Business Name): LUKE GUMINIK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 LAKE LANSING RD STE G6
LANSING MI
48912-3757
US

IV. Provider business mailing address

560 W 465 N STE 604
PROVIDENCE UT
84332-8006
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5101028368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: