Provider Demographics
NPI:1255363644
Name:LUKAC, IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:LUKAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-5015
Mailing Address - Country:US
Mailing Address - Phone:513-531-1555
Mailing Address - Fax:513-531-2068
Practice Address - Street 1:5002 RIDGE AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-5015
Practice Address - Country:US
Practice Address - Phone:513-531-1555
Practice Address - Fax:513-531-2068
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038535L207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services