Healthcare Provider Details

I. General information

NPI: 1316911498
Provider Name (Legal Business Name): JAMES RANDOLPH LULEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 209
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE 209
DEARBORN MI
48124-5032
US

V. Phone/Fax

Practice location:
  • Phone: 313-271-8560
  • Fax: 313-271-2831
Mailing address:
  • Phone: 313-271-8560
  • Fax: 313-271-2831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301035314
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301035314
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: