Provider Demographics
NPI:1497140925
Name:LUKAS, STEPHANIE ANNE MASUCK (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE MASUCK
Last Name:LUKAS
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 1:4205 BEN FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2143
Mailing Address - Country:US
Mailing Address - Phone:919-477-6900
Mailing Address - Fax:
Practice Address - Street 1:4205 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-477-6900
Practice Address - Fax:919-620-0974
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT42282207R00000X
NC2019-02500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1497140925Medicaid
MTMED-RES-LIC-42282OtherSTATE OF MONTANA