Provider Demographics
NPI:1285821538
Name:LUKAS, CAROL (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:LUKAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:ISU-OBSERVATION UNIT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-982-5770
Practice Address - Fax:313-982-5771
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704208250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
11904589OtherCAQH
MI1285821538Medicaid