Provider Demographics
NPI:1700377835
Name:LUKERT, NICHOLAS DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DANIEL
Last Name:LUKERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-967-6400
Mailing Address - Fax:954-337-5755
Practice Address - Street 1:77 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9571
Practice Address - Country:US
Practice Address - Phone:863-699-5437
Practice Address - Fax:863-699-9000
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME148735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics