Individual
DR. KYLE G LUECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 7TH AVE N, ST PETERSBURG, FL 33705-1300
(727) 825-1100
Mailing address
PO BOX 919379, ORLANDO, FL 32891-0001
(844) 453-1406
(772) 621-3180
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101264153
VA
2085R0202X
Diagnostic Radiology Physician
Primary
ME140753
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103610100
—
FL
05
—
1063754729
—
VA
01
—
LN182
FL MEDICARE PTAN
FL
01
—
OBE1C
FL BCBS
FL
01
—
P02293237
FL RAILROAD MEDICARE PTAN
FL
Enumeration date
03/20/2013
Last updated
08/03/2021
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