Provider Demographics
NPI:1346248374
Name:LUCAS, CHRISTINE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1668
Mailing Address - Country:US
Mailing Address - Phone:618-833-4471
Mailing Address - Fax:618-833-6267
Practice Address - Street 1:513 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1668
Practice Address - Country:US
Practice Address - Phone:618-833-4471
Practice Address - Fax:618-833-6267
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-07-21
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-05-01
Provider Licenses
StateLicense IDTaxonomies
IL036-099486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099486OtherIDPA FEE FOR SERVICE
IL048870OtherHEALTH ALLIANCE
IL415518OtherHEALTHLINK
ILG96923OtherTRICARE
ILG96923OtherBLUE CROSS BLUE SHIELD
IL036-099486Medicaid
ILG96923OtherUNITED HEALTHCARE RR MEDI
ILG96923OtherCHAMPVA
ILG96923OtherCHAMPVA
IL415518OtherHEALTHLINK