Provider Demographics
NPI:1396586913
Name:LUKAS, GARRON MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:GARRON
Middle Name:MICHAEL
Last Name:LUKAS
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 1:16 RAVEN RD
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-3127
Mailing Address - Country:US
Mailing Address - Phone:217-493-1316
Mailing Address - Fax:
Practice Address - Street 1:16 RAVEN RD
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-3127
Practice Address - Country:US
Practice Address - Phone:217-493-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD26507208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery