Provider Demographics
NPI:1689659427
Name:LUCEK, DONALD W (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:LUCEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-1146
Mailing Address - Country:US
Mailing Address - Phone:605-845-8170
Mailing Address - Fax:
Practice Address - Street 1:1309 10TH AVE W
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-1146
Practice Address - Country:US
Practice Address - Phone:605-845-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4036208600000X
MN42530208600000X
WI51171208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN020050950OtherMEDICARE - RAILROAD
MNHP30630OtherHEALTH PARTNERS
MN021M4LUOtherMNCARE
MN1700792, 3909161OtherMEDICA
MNNA9501023797OtherPREFERRED ONE
MN021M4LU, 070L6LUOtherBCBS
MN611829100Medicaid
MN127977OtherMNCARE-U
MN363606405OtherCHAMPUS
MN363606405OtherSVHP
MN363606405OtherCHAMPUS
MNHP30630OtherHEALTH PARTNERS