Healthcare Provider Details

I. General information

NPI: 1558604306
Provider Name (Legal Business Name): LUCAS DONALD-FRED WATTS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2013
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HEALTH DR SW
WYOMING MI
49519-9691
US

IV. Provider business mailing address

2093 HEALTH DR SW
WYOMING MI
49519-9691
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-5775
  • Fax:
Mailing address:
  • Phone: 616-252-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5101020451
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: