Healthcare Provider Details

I. General information

NPI: 1851048177
Provider Name (Legal Business Name): LUKAS DAVID TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 S HOWELL AVE STE 1600
OAK CREEK WI
53154-1460
US

IV. Provider business mailing address

7003 S HOWELL AVE STE 1600
OAK CREEK WI
53154-1460
US

V. Phone/Fax

Practice location:
  • Phone: 262-476-4900
  • Fax:
Mailing address:
  • Phone: 262-476-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number7033-23
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: