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General NPI Number Information
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NPI Number | 1083025290
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S PHYSICIAN GROUP INC
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 1101 W EMAUS AVE
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City | ALLENTOWN
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State | PA
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Zip | 18103-6676
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Country | US
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Telephone | 610-682-0624
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Fax |
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Provider Business Mailing Address
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Address Line | 801 OSTRUM ST ENROLLMENT DEPT
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City | BETHLEHEM
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State | PA
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Zip | 18015-1000
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Country | US
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Telephone | 484-426-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEAN W EVANS
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Credential |
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Telephone | 484-526-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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