Provider Demographics
NPI:1750510459
Name:CHRISTINA LUCAS DO
Entity Type:Organization
Organization Name:CHRISTINA LUCAS DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LUCAS-VOUGIOUKLAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-362-7100
Mailing Address - Street 1:5400 FORT ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4632
Mailing Address - Country:US
Mailing Address - Phone:734-362-7100
Mailing Address - Fax:734-671-1768
Practice Address - Street 1:5400 FORT ST
Practice Address - Street 2:SUITE 130
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4632
Practice Address - Country:US
Practice Address - Phone:734-362-7100
Practice Address - Fax:734-671-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty