Healthcare Provider Details

I. General information

NPI: 1174094148
Provider Name (Legal Business Name): ST. LUKE'S PHYSICIAN GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 N 19TH ST
ALLENTOWN PA
18104-4039
US

IV. Provider business mailing address

842 N 19TH ST
ALLENTOWN PA
18104-4039
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-6119
  • Fax: 610-437-4280
Mailing address:
  • Phone: 610-437-6119
  • Fax: 610-437-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN W. EVANS
Title or Position: PRESIDENT
Credential:
Phone: 484-526-3383