Provider Demographics
NPI:1104819887
Name:MOSEMANN, LUKE B (MD)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:B
Last Name:MOSEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:IN
Mailing Address - Zip Code:47452-1724
Mailing Address - Country:US
Mailing Address - Phone:812-865-3350
Mailing Address - Fax:812-865-3814
Practice Address - Street 1:260 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:IN
Practice Address - Zip Code:47452-1724
Practice Address - Country:US
Practice Address - Phone:812-865-3350
Practice Address - Fax:812-865-3814
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100151590BMedicaid
INC25407Medicare UPIN
IN100151590BMedicaid