Provider Demographics
NPI:1407890882
Name:LUCAS, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-206C
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-9745
Mailing Address - Fax:269-349-1013
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-206C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-9745
Practice Address - Fax:269-349-1013
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
MI4301037689208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
111760OtherGREAT LAKES HLTH PLN
MI3403957061OtherBCBS IND PIN
MI340C910480OtherBCBS GRP PIN
MI2999271-10Medicaid
4361735OtherAETNA PIN
4361735OtherAETNA PIN
4361735OtherAETNA PIN
MI3403957061OtherBCBS IND PIN
MI340010983Medicare PIN
MI340010983Medicare PIN