Provider Demographics
NPI:1053506139
Name:LUKITSCH, MELISSA ANN (LMT, BA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:LUKITSCH
Suffix:
Gender:F
Credentials:LMT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 CATTARAUGUS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-9641
Mailing Address - Country:US
Mailing Address - Phone:176-592-3808
Mailing Address - Fax:
Practice Address - Street 1:1620 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4500
Practice Address - Country:US
Practice Address - Phone:716-592-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015896-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist