Healthcare Provider Details

I. General information

NPI: 1215661707
Provider Name (Legal Business Name): PHILIP LUKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S GRANT AVE
COLUMBUS OH
43215-5537
US

IV. Provider business mailing address

360 S GRANT AVE
COLUMBUS OH
43215-5537
US

V. Phone/Fax

Practice location:
  • Phone: 614-398-3470
  • Fax:
Mailing address:
  • Phone: 614-398-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: