Provider Demographics
NPI:1407681505
Name:LUMA PODIATRY & WOUND CARE, PLLC
Entity type:Organization
Organization Name:LUMA PODIATRY & WOUND CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:KURTZ PHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:603-205-4501
Mailing Address - Street 1:10 GROSVENOR PARK
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3122
Mailing Address - Country:US
Mailing Address - Phone:603-205-4501
Mailing Address - Fax:
Practice Address - Street 1:585 LEBANON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3225
Practice Address - Country:US
Practice Address - Phone:781-979-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center