Provider Demographics
NPI:1689275406
Name:MILLER, LUCAS PAUL (PA-C)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:PAUL
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 BRIGHTON OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9606
Mailing Address - Country:US
Mailing Address - Phone:810-775-9410
Mailing Address - Fax:
Practice Address - Street 1:14555 LEVAN RD STE 309
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5085
Practice Address - Country:US
Practice Address - Phone:734-462-5858
Practice Address - Fax:734-462-5860
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant