Healthcare Provider Details

I. General information

NPI: 1831457779
Provider Name (Legal Business Name): LUKE MCCRONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2012
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MITCHELL ST STE M40
PETOSKEY MI
49770
US

IV. Provider business mailing address

560 W MITCHELL ST STE M40
PETOSKEY MI
49770-2278
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-2391
  • Fax: 231-487-6513
Mailing address:
  • Phone: 231-487-2391
  • Fax: 231-487-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301114164
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: