Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 4301097403 | MI |
NPI | 1326053083 |
---|---|
Provider Name | Ali Maria Luck |
First Address | West Bloomfield, MI 48322-3013 |
Second Address | West Bloomfield, MI 48322-3013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 18/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26730 | WELLMARK BCBS (01) | IA |
I18381 | (02) |