Healthcare Provider Details

I. General information

NPI: 1821319633
Provider Name (Legal Business Name): LILANA LUCAJ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 10/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26000 HOOVER RD STE 102
WARREN MI
48089-1167
US

IV. Provider business mailing address

13430 E 13 MILE RD
WARREN MI
48088-3187
US

V. Phone/Fax

Practice location:
  • Phone: 586-427-1351
  • Fax:
Mailing address:
  • Phone: 586-427-1351
  • Fax: 586-486-5669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: