MEDICARE: TIM T. LUK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	036082926	IL

General Provider Information

NPI Number	:	1356343321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIM T. LUK D.O.

Provider Business Mailing Address
First Line	:	3998 FAIR RIDGE DR
Second Line	:	STE 300
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2921
Country	:	US
Telephone Number	:	703-293-9590
Fax Number	:	703-766-9725

Provider Business Practice Location Address
First Line	:	3 ERIE CT
Second Line	:	WEST SUBURBAN MEDICAL CENTER
City	:	OAK PARK
State	:	IL
Zip	:	60302-2519
Country	:	US
Telephone Number	:	708-783-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/20/2015

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