Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301025345 | MI |
Y | 208600000X | Surgeon | 4301025345 | MI |
NPI | 1013955137 |
---|---|
Provider Name | Charles Edward Lucas |
First Address | Troy, MI 48083-1189 |
Second Address | Detroit, MI 48201-2020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 19/02/2016 |