Healthcare Provider Details

I. General information

NPI: 1508800293
Provider Name (Legal Business Name): JONATHAN S LUCHS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 DISCOVERY DR STE 100
LANSING MI
48910-8609
US

IV. Provider business mailing address

224 7TH ST 3RD FLOOR
GARDEN CITY NY
11530-5774
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-8930
  • Fax: 517-337-4985
Mailing address:
  • Phone: 516-747-0161
  • Fax: 516-873-6548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number209483
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number209483
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301098401
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: