Provider Demographics
NPI:1770929010
Name:GIERUT, LUKASZ EDWARD (DO)
Entity type:Individual
Prefix:
First Name:LUKASZ
Middle Name:EDWARD
Last Name:GIERUT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BUDINGER AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4137
Mailing Address - Country:US
Mailing Address - Phone:407-892-3387
Mailing Address - Fax:407-892-7297
Practice Address - Street 1:1330 BUDINGER AVE STE 108
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4137
Practice Address - Country:US
Practice Address - Phone:407-892-3387
Practice Address - Fax:407-892-7297
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.062783207Q00000X
FLOS13932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine