Basic Information
| Provider Information | |||||||||
| NPI: | 1457300840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LU | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | Y | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 W FAIRBANKS AVE | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327894603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079750200 | ||||||||
| FaxNumber: | 4079750209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N. GRAND AVE. | ||||||||
| Address2: | STE 508 | ||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810032757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195957040 | ||||||||
| FaxNumber: | 7195957045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | ME66562 | FL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | DR.0057976 | CO | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 376174600 | 05 | FL | MEDICAID | 9000145001 | 05 | CO | MEDICAID |