Provider Demographics
NPI:1679816813
Name:LUCAS, RACHEL CREA (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CREA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CASSIDY AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2503
Mailing Address - Country:US
Mailing Address - Phone:952-412-5669
Mailing Address - Fax:
Practice Address - Street 1:4855 N. MOORLAND ROAD
Practice Address - Street 2:URGENT CARE CLINIC
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7494
Practice Address - Country:US
Practice Address - Phone:262-432-7599
Practice Address - Fax:262-432-7694
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY052592080H0002X, 2080H0002X
WI63288-21208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679816813Medicaid