Provider Demographics
NPI:1407817992
Name:LUKOFF, PHILIP FABER (DPM)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:FABER
Last Name:LUKOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S QUINSIGAMOND AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4279
Mailing Address - Country:US
Mailing Address - Phone:508-650-3668
Mailing Address - Fax:
Practice Address - Street 1:192 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2252
Practice Address - Country:US
Practice Address - Phone:508-650-3668
Practice Address - Fax:508-650-1159
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1735174400000X, 213E00000X, 213EP1101X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No174400000XOther Service ProvidersSpecialist
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery