Provider Demographics
NPI:1306056064
Name:LUECK, NATHAN E (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:E
Last Name:LUECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 385760
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-5760
Mailing Address - Country:US
Mailing Address - Phone:952-994-1964
Mailing Address - Fax:952-303-6713
Practice Address - Street 1:6500 EXCELSIOR BLVD.
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-5290
Practice Address - Fax:952-993-6193
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAR-7566207ZP0102X
MN51509207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology