Organization
LUMA HEALTHCARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA DE ELEJALDE (EXECUTIVE VICE PRESIDENT)
(414) 228-0100
Entity
Organization
Contact information
Practice address
1919 W NORTH AVE # 200, MILWAUKEE, WI 53205-1153
(414) 287-1000
Mailing address
2311 W GOOD HOPE RD, GLENDALE, WI 53209-2735
(414) 228-0100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207SG0201X
Clinical Genetics (M.D.) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VX0000X
Obstetrics Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972861623
—
WI
Enumeration date
05/01/2012
Last updated
07/09/2013
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