1376678128 NPI number — MR. PAUL LUKOWIAK PT

Table of content: MR. PAUL LUKOWIAK PT (NPI 1376678128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376678128 NPI number — MR. PAUL LUKOWIAK PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKOWIAK
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376678128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4027 S 1330 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENTOWN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46936-9774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-628-7018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2146 E MARKLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOKOMO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46901-6240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-454-9748
Provider Business Practice Location Address Fax Number:
765-454-9759
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  05006820A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251P0200X , with the licence number: 05006820A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000375492 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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