Individual
HEIDI LUCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1179 HERITAGE DR, CANTON, MI 48188-1237
(734) 787-8635
Mailing address
1179 HERITAGE DR, CANTON, MI 48188-1237
(734) 787-8635
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601001749
MI
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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