Healthcare Provider Details

I. General information

NPI: 1386371201
Provider Name (Legal Business Name): CHAD EUGENE LUKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N 900 W
OREM UT
84057-7701
US

IV. Provider business mailing address

811 N 900 W
OREM UT
84057-7701
US

V. Phone/Fax

Practice location:
  • Phone: 801-434-7600
  • Fax: 801-434-7604
Mailing address:
  • Phone: 801-434-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7809946-8002
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: