MEDICARE: MR. LUKE GERARD NELLIGAN 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	207Q00000X	Family Medicine Physician	02001548	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000520470	OTHER		ANTHEM
2	000000632914	OTHER	IN	BC/BS PIKE MEDICAL
3	5428035	OTHER		AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	15D1069058	OTHER	IN	CLIA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	768544	OTHER		CIGNA

General Provider Information

NPI Number	:	1578540522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUKE GERARD NELLIGAN D.O.

Provider Business Mailing Address
First Line	:	55 BRENDON WAY
Second Line	:	SUITE 800
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1961
Country	:	US
Telephone Number	:	317-733-8780
Fax Number	:	866-246-1514

Provider Business Practice Location Address
First Line	:	1329 WEST 96TH STREET
Second Line	:	EXCELL FOR LIFE
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260
Country	:	US
Telephone Number	:	317-660-0888
Fax Number	:	317-660-0880

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	02/26/2013

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Directions to “ MR. LUKE GERARD NELLIGAN D.O.” Practice Location

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