Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036135944 | IL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036135944 | IL |
NPI | 1174783880 |
---|---|
Provider Name | Lucas Casey Armstrong |
First Address | Bloomington, IL 61704-3738 |
Second Address | Bloomington, IL 61704-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 08/09/2016 |