Provider Demographics
NPI:1932390317
Name:LUTSKOVSKY, ANDREY (DO)
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:LUTSKOVSKY
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 1:31000 TELEGRAPH RD
Mailing Address - Street 2:STE. 140
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4360
Mailing Address - Country:US
Mailing Address - Phone:248-480-0895
Mailing Address - Fax:248-480-0705
Practice Address - Street 1:31000 TELEGRAPH RD
Practice Address - Street 2:STE. 140
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4360
Practice Address - Country:US
Practice Address - Phone:248-480-0895
Practice Address - Fax:248-480-0705
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine