MEDICARE: ROBERT BRADLEY LUCAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35067424L	OH

General Provider Information

NPI Number	:	1669554986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BRADLEY LUCAS MD

Provider Business Mailing Address
First Line	:	40 WINDING RIVER TRL
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3607
Country	:	US
Telephone Number	:	440-893-9196
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 CLAGUE RD STE 1100A
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1590
Country	:	US
Telephone Number	:	216-383-0100
Fax Number	:	216-383-6481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	11/05/2012

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