MEDICARE: SKYE LU DO

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	208000000X	Pediatrics Physician	0102205670	VA
2	390200000X	Student in an Organized Health Care Education/Training Program	5151011570	MI

General Provider Information

NPI Number	:	1609224559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYE LU DO

Provider Business Mailing Address
First Line	:	1000 OAKLAND DR
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-1282
Country	:	US
Telephone Number	:	269-337-6019
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 CHARLES H DIMMOCK PKWY STE 600
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2988
Country	:	US
Telephone Number	:	804-518-3288
Fax Number	:	888-990-1241

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

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	07/09/2019

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Directions to “ SKYE LU DO” Practice Location

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