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General NPI Number Information
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NPI Number | 1619332475
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Entity Type | Individual
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Provider Name | JOHN D LUCK M.D
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Gender | Male
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 5401 OLD COURT RD DEPT OF
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5103
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Country | US
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Telephone | 410-521-2200
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Fax | 410-496-7530
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Provider Business Mailing Address
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Address Line | 303 E NICOLLET BLVD SUITE 330
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City | BURNSVILLE
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State | MN
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Zip | 55337
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Country | US
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Telephone | 952-435-0177
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Fax | 952-435-6287
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 77877
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D90135
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License Number State | MD
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