Provider Demographics
NPI:1114530052
Name:MATSEL, LUKAS GENE (DPT)
Entity Type:Individual
Prefix:DR
First Name:LUKAS
Middle Name:GENE
Last Name:MATSEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-2264
Mailing Address - Country:US
Mailing Address - Phone:618-384-6927
Mailing Address - Fax:
Practice Address - Street 1:108 APRIL AVE
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1577
Practice Address - Country:US
Practice Address - Phone:618-382-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025419208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation