Provider Demographics
NPI:1558397976
Name:BLIGNAUT, LUKAS C (MD)
Entity Type:Individual
Prefix:
First Name:LUKAS
Middle Name:C
Last Name:BLIGNAUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5754
Mailing Address - Country:US
Mailing Address - Phone:239-624-4443
Mailing Address - Fax:239-436-5907
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-624-4443
Practice Address - Fax:239-436-5907
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1016882085R0202X
SCMD334822085R0202X
KS295482085R0202X
FL1016882085R0202X
GA0607992085R0202X
KY407702085R0202X
IN01062817A2085R0202X
TXM85402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14F4GOtherBCBS
FL102472700Medicaid
KS12149457OtherMULTIPLAN
KS100413210AMedicaid
KS101759OtherBCBS
IN200839110Medicaid
KY000000541916OtherBLUE CROSS BLUE SHIELD
KYP00476261OtherMEDICARE RAILROAD KENTUCKY
KS203730OtherHPK
KY7100009280Medicaid
KY002800347OtherKENTUCKY MEDICARE
KS121198OtherCOVENTRY
KS13805OtherPHS
FLFF1822Medicare PIN
KS13805OtherPHS
IN200839110Medicaid