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General NPI Number Information
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NPI Number | 1417000506
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Entity Type | Organization
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Legal Business Name | HAROLD LUKE MD INC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 01/10/2009
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Provider Practice Location Address
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Address Line | 137 E VINE ST
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City | REDLANDS
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State | CA
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Zip | 92373-4759
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Country | US
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Telephone | 909-793-0077
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Fax | 909-793-8262
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Provider Business Mailing Address
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Address Line | 137 E VINE ST
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City | REDLANDS
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State | CA
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Zip | 92373-4759
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Country | US
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Telephone | 909-793-0077
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Fax | 909-793-8262
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Authorized Official
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Title or Position | CEO
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Name | HAROLD POHANG LUKE
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Credential | MD
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Telephone | 909-793-0077
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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 | G024934
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License Number State | CA
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