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: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36475 FIVE MILE RD
LIVONIA MI
48154-1971
US

IV. Provider business mailing address

36475 FIVE MILE RD
LIVONIA MI
48154-1971
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-4800
  • Fax: 734-655-2911
Mailing address:
  • Phone: 734-655-4800
  • Fax: 734-655-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5101028368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: