| Lucas Medical Llc | |
|
2109 Hartford Ave Johnston RI 02919-3246 | |
| (626) 319-5932 | |
| Not Available |
| Full Name | Lucas Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2109 Hartford Ave, Johnston, Rhode Island |
| Authorized Official Name and Position | Brian Mikolasko (PRESIDENT, CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6263195932 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lucas Medical Llc 47 Wood Ave Ste 2 Barrington RI 02806-3503 Ph: (626) 319-5932 | Lucas Medical Llc 2109 Hartford Ave Johnston RI 02919-3246 Ph: (626) 319-5932 |
| NPI Number | 1134947997 |
|---|---|
| Provider Enumeration Date | 10/01/2024 |
| Last Update Date | 10/01/2024 |
| Medicare PECOS PAC ID | 2163958059 |
|---|---|
| Medicare Enrollment ID | O20241216003299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134947997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian D Mikolasko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346669512 PECOS PAC ID: 5496021768 Enrollment ID: I20181126003221 |
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