Provider Demographics
NPI:1740278076
Name:LUKASEK, DONNA M (DO)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:LUKASEK
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:PO BOX 2406
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-2406
Mailing Address - Country:US
Mailing Address - Phone:479-709-7490
Mailing Address - Fax:479-709-7495
Practice Address - Street 1:1500 DODSON AVE
Practice Address - Street 2:STE 230
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5182
Practice Address - Country:US
Practice Address - Phone:479-709-7490
Practice Address - Fax:479-709-7495
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100124920BMedicaid
AR146292003Medicaid
AR5M153Medicare PIN
AR146292003Medicaid