Provider Demographics
NPI:1114997947
Name:LUKACSIK, LADISLAV (MD)
Entity Type:Individual
Prefix:
First Name:LADISLAV
Middle Name:
Last Name:LUKACSIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LAKE SHORE DR S
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939-3178
Mailing Address - Country:US
Mailing Address - Phone:630-885-0835
Mailing Address - Fax:
Practice Address - Street 1:525 LAKE SHORE DR S
Practice Address - Street 2:
Practice Address - City:GOREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62939-3178
Practice Address - Country:US
Practice Address - Phone:630-885-0835
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD64531Medicare UPIN