Basic Information
| Provider Information | |||||||||
| NPI: | 1609428119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUKEY | ||||||||
| FirstName: | MATHEW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 EBAUGH ST | ||||||||
| Address2: | METHODIST PHYSICIANS CLINIC GLENWOOD | ||||||||
| City: | GLENWOOD | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125275204 | ||||||||
| FaxNumber: | 7125279346 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 EBAUGH ST | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515341811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125275204 | ||||||||
| FaxNumber: | 7125279346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2019 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD-49462 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 8557 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.