Provider Demographics
NPI:1780644914
Name:KIM M LUCAS MD PLLC
Entity Type:Organization
Organization Name:KIM M LUCAS MD PLLC
Other - Org Name:INTEGRATED ASSOCIATES IN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MYRIAM
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-775-4110
Mailing Address - Street 1:1968 E. BASELINE RD. STE. F101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283
Mailing Address - Country:US
Mailing Address - Phone:480-775-4110
Mailing Address - Fax:480-413-1818
Practice Address - Street 1:1968 E. BASELINE RD. STE. F101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283
Practice Address - Country:US
Practice Address - Phone:480-775-4110
Practice Address - Fax:480-413-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22059261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22059OtherSTATE LIC
AZ03D0973410OtherCLIA
AZ03D0973410OtherCLIA
AZZ82864Medicare PIN
AZ03D0973410OtherCLIA