Provider Demographics
NPI:1285714477
Name:LUFT, MICHAEL P (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:LUFT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2614
Mailing Address - Country:US
Mailing Address - Phone:712-265-2700
Mailing Address - Fax:712-263-1777
Practice Address - Street 1:100 MEDICAL PKWY STE A
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2614
Practice Address - Country:US
Practice Address - Phone:712-265-2700
Practice Address - Fax:712-263-1777
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG63097Medicare UPIN