Healthcare Provider Details

I. General information

NPI: 1669264461
Provider Name (Legal Business Name): LUCAS ANTHONY CIULLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28080 GRAND RIVER AVENUE 208 NORTH
FARMINGTON HILLS MI
48336-5919
US

IV. Provider business mailing address

28050 GRAND RIVER AVE
FARMINGTON HILLS MI
48336-5919
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-8030
  • Fax: 248-471-8383
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151017305
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: