Provider Demographics
NPI:1790939304
Name:LUKANC, MARNEY J (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARNEY
Middle Name:J
Last Name:LUKANC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2764
Mailing Address - Country:US
Mailing Address - Phone:216-407-7664
Mailing Address - Fax:216-581-0693
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-407-7664
Practice Address - Fax:216-581-0693
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.008876171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor