Healthcare Provider Details

I. General information

NPI: 1861345308
Provider Name (Legal Business Name): CAMERON LUCAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 MEDICAL PARK DR SE
GRAND RAPIDS MI
49546-3685
US

IV. Provider business mailing address

287 TIMBER CREEK CIR NW
COMSTOCK PARK MI
49321-8569
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: