Healthcare Provider Details

I. General information

NPI: 1962697573
Provider Name (Legal Business Name): ROY MICHAEL LUKAT M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S HIGHWAY 27 STE. 100
SOMERSET KY
42501-3445
US

IV. Provider business mailing address

445 S HIGHWAY 27 STE. 100
SOMERSET KY
42501-3445
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-3866
  • Fax:
Mailing address:
  • Phone: 606-679-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberKY-0264
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberKY-0264
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberKY-0264
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberKY-0264
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberKY-0691
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: