Provider Demographics
NPI:1134947997
Name:LUCAS MEDICAL LLC
Entity type:Organization
Organization Name:LUCAS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKOLASKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-319-5932
Mailing Address - Street 1:47 WOOD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3503
Mailing Address - Country:US
Mailing Address - Phone:626-319-5932
Mailing Address - Fax:626-380-2395
Practice Address - Street 1:2109 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3246
Practice Address - Country:US
Practice Address - Phone:626-319-5932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty