MEDICARE: MR. DAVOR A LUKETIC MD

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	2085R0202X	Diagnostic Radiology Physician	11224	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	511-56300	OTHER	AL	BLUE CROSS
4	051539419	OTHER	AL	BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1610041	OTHER	AL	UHC
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	051540337	OTHER	AL	BLUE CROSS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	051012861	OTHER	AL	BLUE CROSS
11	4006199	OTHER	AL	AETNA
12	511-09781	OTHER	AL	BLUE CROSS
13	051526312	OTHER	AL	BLUE CROSS
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	515-94619	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1700881984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVOR A LUKETIC MD

Provider Business Mailing Address
First Line	:	2000 A SOUTHBRIDGE PARKWAY
Second Line	:	STE 300
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209
Country	:	US
Telephone Number	:	205-871-4274
Fax Number	:	205-871-4301

Provider Business Practice Location Address
First Line	:	701 PRINCETON AVENUE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211
Country	:	US
Telephone Number	:	205-783-3700
Fax Number	:

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	12/30/2015

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