Individual
DR. LUCAS BERGHOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2516 E DUPONT RD, FORT WAYNE, IN 46825-1608
(260) 458-3035
(260) 458-3036
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 458-3035
(260) 458-3036
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02005944A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02005944A
IN
Other
Enumeration date
04/11/2017
Last updated
03/28/2022
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