Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 4301097135 | MI |
NPI | 1013229681 |
---|---|
Provider Name | Cheryl Lukins |
First Address | Grand Rapids, MI 49503-2526 |
Second Address | Grand Rapids, MI 49503-2526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2010 |
Last Update Date | 11/07/2010 |