Provider Demographics
NPI:1114953262
Name:IWANCZYK, LUKASZ (MD)
Entity Type:Individual
Prefix:DR
First Name:LUKASZ
Middle Name:
Last Name:IWANCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:147 N BRENT ST
Mailing Address - Street 2:HOSPITALIST DEPARTMENT
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2809
Mailing Address - Country:US
Mailing Address - Phone:805-652-5652
Mailing Address - Fax:805-648-5982
Practice Address - Street 1:5855 OLIVAS PARK DR
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7672
Practice Address - Country:US
Practice Address - Phone:805-667-2801
Practice Address - Fax:805-667-2865
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA79334207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114953262OtherMEDICARE WA79334C
CAH93787Medicare UPIN