MEDICARE: ANDREW LUCAS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972446391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LUCAS

Provider Business Mailing Address
First Line	:	2040 ROSEANN DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2720
Country	:	US
Telephone Number	:	586-922-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	RADIATION MEDICINE 800 ROSE ST PAV H C118
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	586-922-9199
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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