Healthcare Provider Details

I. General information

NPI: 1639050750
Provider Name (Legal Business Name): VIRGINIA OKEMA LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25935 ARLINGTON ST
ROSEVILLE MI
48066-3996
US

IV. Provider business mailing address

25935 ARLINGTON ST
ROSEVILLE MI
48066-3996
US

V. Phone/Fax

Practice location:
  • Phone: 313-208-4987
  • Fax:
Mailing address:
  • Phone: 313-208-4987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: