Provider Demographics
NPI:1588651418
Name:LUKASEK, DUANE A (DO)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:A
Last Name:LUKASEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11450
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:479-709-1924
Mailing Address - Fax:479-709-7499
Practice Address - Street 1:8600 S 36TH TER
Practice Address - Street 2:STE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8768
Practice Address - Country:US
Practice Address - Phone:479-709-7422
Practice Address - Fax:479-709-7468
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200182570AMedicaid
AR174694003Medicaid
ARF94570Medicare UPIN
AR5AB55Medicare PIN