Provider Demographics
NPI:1679654578
Name:LUKASZEWICZ, ADELE (MD)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:
Last Name:LUKASZEWICZ
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:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MT
Mailing Address - Zip Code:59349-0848
Mailing Address - Country:US
Mailing Address - Phone:406-635-5459
Mailing Address - Fax:
Practice Address - Street 1:210 S WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-4742
Practice Address - Country:US
Practice Address - Phone:140-687-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine