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NPI Code Detail

MEDICARE: TIM T. LUK D.O.

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
1207L00000XAnesthesiology Physician036082926IL

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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