Healthcare Provider Details

I. General information

NPI: 1982056768
Provider Name (Legal Business Name): LUKE HARBERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WASHINGTON AVE STE 101
MOUNT PLEASANT WI
53406-6516
US

IV. Provider business mailing address

7200 WASHINGTON AVE STE 101
MOUNT PLEASANT WI
53406-6516
US

V. Phone/Fax

Practice location:
  • Phone: 414-939-5447
  • Fax: 262-583-1769
Mailing address:
  • Phone: 414-939-5447
  • Fax: 262-583-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3779-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: