MEDICARE: LUKE HARBERS PA-C

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	363AS0400X	Surgical Physician Assistant	3779-23	WI

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

General Provider Information

NPI Number	:	1982056768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE HARBERS PA-C

Provider Business Mailing Address
First Line	:	7200 WASHINGTON AVE STE 101
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-6516
Country	:	US
Telephone Number	:	414-939-5447
Fax Number	:	262-583-1769

Provider Business Practice Location Address
First Line	:	7200 WASHINGTON AVE STE 101
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-6516
Country	:	US
Telephone Number	:	414-939-5447
Fax Number	:	262-583-1769

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

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	09/10/2025

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Directions to “ LUKE HARBERS PA-C” Practice Location

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