Individual
LUCKNER ISME I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
26736 SAVILLE AVE, BONITA SPRINGS, FL 34135-6339
(239) 213-8179
Mailing address
26736 SAVILLE AVE, BONITA SPRINGS, FL 34135-6339
(239) 213-8179
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
I250520832670
FL
172A00000X
Driver
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—
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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