Provider Demographics
NPI:1316221963
Name:DR LUKES FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:DR LUKES FAMILY MEDICINE LLC
Other - Org Name:JAMES P. LUKAVSKY, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LUKAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-337-7511
Mailing Address - Street 1:1015 STATE HIGHWAY 248
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8002
Mailing Address - Country:US
Mailing Address - Phone:417-337-7511
Mailing Address - Fax:417-336-9769
Practice Address - Street 1:1015 STATE HIGHWAY 248
Practice Address - Street 2:SUITE B
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8002
Practice Address - Country:US
Practice Address - Phone:417-337-7511
Practice Address - Fax:417-336-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty