MEDICARE: LUKAS DAVID TORRES

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	202K00000X	Phlebology Physician	7033-23	WI
2	363A00000X	Physician Assistant	7033	WI

General Provider Information

NPI Number	:	1851048177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKAS DAVID TORRES

Provider Business Mailing Address
First Line	:	7003 S HOWELL AVE STE 1600
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-1460
Country	:	US
Telephone Number	:	262-476-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 S HOWELL AVE STE 1600
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-1460
Country	:	US
Telephone Number	:	262-476-4900
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	01/08/2025

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Directions to “ LUKAS DAVID TORRES ” Practice Location

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