Healthcare Provider Details

I. General information

NPI: 1174783880
Provider Name (Legal Business Name): LUCAS CASEY ARMSTRONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 TRINITY LANE SUITE 111
BLOOMINGTON IL
61704-3738
US

IV. Provider business mailing address

1111 TRINITY LANE SUITE 111
BLOOMINGTON IL
61704-3738
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-6461
  • Fax: 309-663-5711
Mailing address:
  • Phone: 309-663-6461
  • Fax: 309-663-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036135944
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number036135944
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: