Healthcare Provider Details

I. General information

NPI: 1538289772
Provider Name (Legal Business Name): WADE LUKKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5000
US

IV. Provider business mailing address

600 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5000
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-3332
  • Fax: 605-232-0854
Mailing address:
  • Phone: 605-232-3332
  • Fax: 605-232-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7029
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number7029
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: