DR. LUKE DAVID WIDSTROM (NPI# 1366886053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366886053 |
| Entity Type | Individual |
| Full Name | DR. LUKE DAVID WIDSTROM |
| Credential | D.O. |
| Practice Address |
400 East Third Street Essentia Health Duluth Clinic Duluth MN 55805-1951 |
| Mailing Address |
400 East Third Street Essentia Health Duluth Clinic Mcl2cred Duluth MN 55805-1951 |
| Practice Telephone | 2187868364 |
| Mailing Telephone | 2187868364 |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2018-05-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
58494 | MN | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | TL.0006261 | CO | Student, Health Care |
| Street Address |
400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC |
| City | DULUTH |
| State | MN |
| Zip Code | 55805-1951 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518944164 | Susan E. Romanik | Family Medicine | 400 East Third Street, Duluth, MN 55805 | 2005-12-26 |
| 1902366396 | William Carson Markes | Physician Assistant | 400 East Third Street, Duluth, MN 55805-1951 | 2019-03-21 |
| 1922517093 | Meghan Eileen Rochefort | Nurse Practitioner | 400 East Third Street, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2017-09-21 |
| 1982140299 | Erin Jane Van Hon | Dietitian, Registered | 400 East Third Street, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2017-01-10 |
| 1770035933 | Jessica Ann Mcdonnell | Nurse Anesthetist, Certified Registered | 400 East Third Street, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2016-11-03 |
| 1760932487 | Jacob Ryan Swette | Acupuncturist | 400 East Third Street, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2016-10-05 |
| 1316494891 | Mallorie Marie Van Winkle | Physical Therapist | 400 East Third Street, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2016-09-01 |
| 1194272781 | Rebecca Leigh Wachsmuth | Nurse Practitioner | 400 East Third Street, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2016-09-01 |
| 1710343165 | Kelsey Ann Sellnow | Physician Assistant | 400 East Third Street, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2016-01-14 |
| 1205241478 | Natalia De Albuquerque Rocha | Internal Medicine | 400 East Third Street, Duluth, MN 55805-1951 | 2014-06-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356852180 | Peace of Mind of Duluth, Inc. | Community/Behavioral Health | 1000 East 1st Street, Suite 100, Duluth, MN 55805 | 2017-10-19 |
| 1891213419 | Arielle Skalisky | Registered Nurse | 400 E. 3rd Street, Duluth, MN 55805 | 2017-09-04 |
| 1457886400 | Chefrdn, LLC | Dietitian, Registered | 1101 East 4th Street, Duluth, MN 55805 | 2017-04-27 |
| 1962811604 | Claire Elena Kap | Nurse Practitioner | Essentia Health Duluth Clnic, 400 East Third Street, Duluth, MN 55805 | 2014-08-06 |
| 1598196313 | Kelsey Lindsay Putvin | Audiologist | 400 E 3rd St., Duluth, MN 55805 | 2013-12-04 |
| 1639462997 | James F Conniff | Family Medicine | Duluth Family Medicine Clinic, 330 N Eighth Ave E, Duluth, MN 55805 | 2011-05-19 |
| 1215237433 | Bobby Jo Mineheine | Speech-Language Pathologist | 530 East Second St, Polinsky Medical Rehab Ctr, Duluth, MN 55805 | 2010-10-22 |
| 1891004248 | Robin Michelle Warfel | Occupational Therapist | 530 East 2nd Street, Polinsky Medical Rehabilitation Center, Duluth, MN 55805 | 2010-10-04 |
| 1154638716 | Jennifer Chen | Pharmacist | 420 E 1st St Mail Drop 1s3w10, Duluth, MN 55805 | 2010-09-02 |
| 1376858084 | Jennifer Lynn Howard | Pharmacist | 211 West Fourth Street, Center for American Indian Resources, Duluth, MN 55805 | 2010-08-18 |
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| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497157168 | Univeristy of Minnesota Duluth | Family Medicine | 1216 Ordean Ct, Duluth, MN 55812-3032 | 2014-09-24 |
| 1942567086 | Carl Peter Rasmussen | Family Medicine | 1400 Woodland Ave, Duluth, MN 55803 | 2012-04-13 |
| 1154498848 | Stephen Curtis Harrington | Family Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-11-29 |
| 1750465985 | Benjamin David Nelson | Family Medicine | 400 East 3rd Street, Duluth, MN 55805 | 2006-10-24 |
| 1619996832 | Kenji Sudoh | Family Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-07-19 |
| 1841228301 | Douglas Frederick Hoffman | Family Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-06-30 |
| 1972539955 | Daniel Lee Mark | Family Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-06-23 |
| 1497790547 | Wade Alan Lillegard | Family Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-06-20 |
| 1730124678 | Ann Caroline Sudoh | Family Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-06-17 |
| 1588610992 | Janus Butcher | Family Medicine | 400 E 3rd St, Duluth, MN 55805-1951 | 2006-05-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.