Provider Demographics
NPI:1134906167
Name:HEILIGENBERG, LUCAS JAMES
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:JAMES
Last Name:HEILIGENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-4102
Mailing Address - Country:US
Mailing Address - Phone:330-553-4212
Mailing Address - Fax:
Practice Address - Street 1:1156 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-4102
Practice Address - Country:US
Practice Address - Phone:330-553-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker