Provider Demographics
NPI:1538182456
Name:LUKE, DEEDEE CANTRELLE (MD)
Entity type:Individual
Prefix:
First Name:DEEDEE
Middle Name:CANTRELLE
Last Name:LUKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 ALBERTSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4349
Mailing Address - Country:US
Mailing Address - Phone:337-445-3545
Mailing Address - Fax:
Practice Address - Street 1:803 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4349
Practice Address - Country:US
Practice Address - Phone:337-445-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1570150Medicaid
LA1570150Medicaid
4A501Medicare ID - Type Unspecified