Organization
MARK S LUEDKE OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK S LUEDKE OD (PRESIDENT)
(863) 604-2020
Entity
Organization
Contact information
Practice address
9433 BALM RIVERVIEW RD, STE 102, RIVERVIEW, FL 33569-5120
(813) 671-2020
(813) 677-5549
Mailing address
9433 BALM RIVERVIEW RD, STE. 102, RIVERVIEW, FL 33569-5120
(813) 671-2020
(813) 677-5549
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
Primary
OPC2762
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620037100
—
FL
Enumeration date
10/03/2008
Last updated
09/25/2014
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