MARK S LUEDKE OD PA; NPI #1134370562

Contact Information

MARK S LUEDKE OD PA

9433 BALM RIVERVIEW RD
STE 102
RIVERVIEW, FL 33569-5120

Phone: 813-671-2020
Fax: 813-677-5549
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Corporate Health	261QC1800X

Indicates primary specialty

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NPI Profile & details for MARK S LUEDKE OD PA

NPI Number 1134370562

LBN Legal business name MARK S LUEDKE OD PA

Authorized official MARK LUEDKE - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 10/03/2008

Last updated 09/25/2014 - About 12 years ago

Identifiers

FL	License #	OPC2762
FL	Medicaid	620037100

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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