Provider Demographics
NPI:1356538052
Name:COSSU AND LUKASIEWICZ P A
Entity type:Organization
Organization Name:COSSU AND LUKASIEWICZ P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-481-2400
Mailing Address - Street 1:6120 WINKLER RD
Mailing Address - Street 2:STE E
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8125
Mailing Address - Country:US
Mailing Address - Phone:239-481-2400
Mailing Address - Fax:239-481-2662
Practice Address - Street 1:6120 WINKLER RD
Practice Address - Street 2:STE E
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8125
Practice Address - Country:US
Practice Address - Phone:239-481-2400
Practice Address - Fax:239-481-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39472Medicare PIN
D60698Medicare UPIN
FL1356538052Medicare NSC
F41837Medicare UPIN
82674ZMedicare PIN
FL80717ZMedicare PIN