Provider Demographics
NPI:1649700592
Name:TSIKITAS, LUCAS ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:ANTHONY
Last Name:TSIKITAS
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 1:246 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4527
Mailing Address - Country:US
Mailing Address - Phone:774-563-0241
Mailing Address - Fax:
Practice Address - Street 1:259 1ST ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3957
Practice Address - Country:US
Practice Address - Phone:516-663-2381
Practice Address - Fax:516-663-8796
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1759072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program