Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 35.095423 | OH |
N | 207U00000X | Nuclear Medicine Specialist | 36497 | IA |
N | 207U00000X | Nuclear Medicine Specialist | ME98885 | FL |
NPI | 1508992470 |
---|---|
Provider Name | Mr. Luke Bolek |
First Address | Miamisburg, OH 45342 |
Second Address | Dayton, OH 45429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 09/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0314542 | (05) | OH |
279088200 | (05) | FL |