Kamilla L Lucht, MD
Individual provider Active NPI Pediatrics Physician · Fargo, ND
NPI 1326080656 · NPPES record last updated Jun 6, 2022
Key facts
- NPI
- 1326080656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 10224 (ND)
- Practice address
- 2701 13TH Ave S
Fargo, ND 58103-3602 - Phone
- (701) 234-3600
- Fax
- (701) 234-3515
- NPI assigned
- Jun 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060828000336 | ND | Practitioner - Pediatric Medicine |
4486658853 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1185 | MN | MD | Pediatrics Physician |
| 10224 | ND | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Medical Center Fargo | Pediatrics | Current |
Accepting new patients |
| Sanford Medical Center Fargo | Current |
Accepting new patients | |
| Sanford Medical Center Fargo | Past | Accepting new patients |
Locations
2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800
2701 13th Ave S
Fargo, ND 58103
Phone (701) 234-3600
1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 1185 | MN | |
| Pediatrics Physician | 208000000X | 10224 | ND | Yes |
Addresses
Primary practice location
2701 13TH Ave S
Fargo, ND 58103-3602
Mailing address
2701 13TH Ave S
Fargo, ND 58103-3602
Phone (701) 234-3600
Other names
- Kamilla L Reed
Other providers in Fargo, ND
- Maari Lynn Loy
- Vicki Jean Loyland
- Yuan Lu
- Erin Eliza Lubitz
- Lorraine Anne Lubka
- Theresa Marie Lucht
- Michael Samuel Lucin
- Maria Lucio
- Megen Lucy
- Rachel Lucy
All providers in Fargo, ND · Pediatrics Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.