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Contact Information

KEVIN GOODLUCK, MD
4600 MONTGOMERY BLVD NE
BLDG B, STE 100
ALBUQUERQUE, NM87109
 Phone: 505-924-5840
 Fax: 505-924-5841
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Phlebology

202K00000X
Indicates primary specialty

NPI Profile & details for KEVIN GOODLUCK · (Male)

NPI # 1710071196
Status Active
Credentials MD
Entity Individual
Enumeration date 10/03/2006
Last updated 01/12/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • NM License # 97-251
  • NM Medicaid 81783311
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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