Provider Demographics
NPI:1679547277
Name:LUKANICH, JEANNE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:LUKANICH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1619
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-794-8050
Practice Address - Fax:413-794-8054
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA151984208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3159388Medicaid
G34318Medicare UPIN
MAA21680Medicare PIN