Provider Demographics
NPI:1669546966
Name:LUKACS, CONNIE S (LPN, ROF)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:LUKACS
Suffix:
Gender:F
Credentials:LPN, ROF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6243 ANDREWS DR E
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9313
Mailing Address - Country:US
Mailing Address - Phone:614-818-3301
Mailing Address - Fax:614-818-3302
Practice Address - Street 1:6243 ANDREWS DR E
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9313
Practice Address - Country:US
Practice Address - Phone:614-818-3301
Practice Address - Fax:614-818-3302
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2506167Medicaid
OH000000334932OtherANTHEM
OH200513653003OtherMEDICAL MUTUAL
OH5000350001Medicare PIN