Provider Demographics
NPI:1699972737
Name:LUKE OBGYN CARE PC
Entity type:Organization
Organization Name:LUKE OBGYN CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-353-9460
Mailing Address - Street 1:30400 TELEGRAPH RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4537
Mailing Address - Country:US
Mailing Address - Phone:248-353-9460
Mailing Address - Fax:248-353-8084
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 350
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4537
Practice Address - Country:US
Practice Address - Phone:248-353-9460
Practice Address - Fax:248-353-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104504490Medicaid
MI160631551OtherBCBS
MID35405Medicare UPIN
MI0N72410Medicare PIN