Provider Demographics
NPI:1164443354
Name:LUKACS, KORNEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KORNEL
Middle Name:
Last Name:LUKACS
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 1:312 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3250
Mailing Address - Country:US
Mailing Address - Phone:814-944-3347
Mailing Address - Fax:814-949-2374
Practice Address - Street 1:312 UNION AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-3250
Practice Address - Country:US
Practice Address - Phone:814-944-3347
Practice Address - Fax:814-949-2374
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037451E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA130003415OtherRAILROAD MEDICARE
PA0011351960006Medicaid
PA189242OtherPA BLUE SHIELD
PA189242OtherPA BLUE SHIELD
PA130003415OtherRAILROAD MEDICARE