Provider Demographics
NPI:1225668635
Name:TOMASZEK, LUCKY J (LM)
Entity Type:Individual
Prefix:
First Name:LUCKY
Middle Name:J
Last Name:TOMASZEK
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 HOGEBOOM AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4354
Mailing Address - Country:US
Mailing Address - Phone:414-975-2090
Mailing Address - Fax:
Practice Address - Street 1:1815 HOGEBOOM AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4354
Practice Address - Country:US
Practice Address - Phone:414-975-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI245-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife