Provider Demographics
NPI:1356559496
Name:LUCAS-VOUGIOUKLAKIS, CHRISTINA M (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:LUCAS-VOUGIOUKLAKIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-4222
Mailing Address - Country:US
Mailing Address - Phone:734-240-4594
Mailing Address - Fax:
Practice Address - Street 1:650 STEWART RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-4222
Practice Address - Country:US
Practice Address - Phone:734-240-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H27501OtherBLUE CROSS
1841564788OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H27501OtherBLUE CROSS