Provider Demographics
NPI: | 1164662243 |
---|---|
Name: | ZEF LUCAJ MD PC |
Entity Type: | Organization |
Organization Name: | ZEF LUCAJ MD PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/NEUROLOGIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ZEF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LUCAJ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 586-263-0610 |
Mailing Address - Street 1: | 15945 19 MILE RD |
Mailing Address - Street 2: | SUITE 106 |
Mailing Address - City: | CLINTON TWP |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48038-1147 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 586-263-0610 |
Mailing Address - Fax: | 586-263-0834 |
Practice Address - Street 1: | 15945 19 MILE RD |
Practice Address - Street 2: | SUITE 106 |
Practice Address - City: | CLINTON TWP |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48038-1147 |
Practice Address - Country: | US |
Practice Address - Phone: | 586-263-0610 |
Practice Address - Fax: | 586-263-0834 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-02 |
Last Update Date: | 2009-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | ZL068629 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |