Healthcare Provider Details

I. General information

NPI: 1346821238
Provider Name (Legal Business Name): LUKE KIEFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE FL 2
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

1468 MADISON AVE FL 2
NEW YORK NY
10029-6508
US

V. Phone/Fax

Practice location:
  • Phone: 310-850-5579
  • Fax:
Mailing address:
  • Phone: 310-850-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number336891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: