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General NPI Number Information
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NPI Number | 1275777039
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Entity Type | Individual
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Provider Name | ISMET LUKOLIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 100 RAWLINS DR
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City | SEAFORD
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State | DE
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Zip | 19973-5881
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Country | US
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Telephone | 302-990-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 800 POLY PL
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City | BROOKLYN
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State | NY
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Zip | 11209-7104
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Country | US
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Telephone | 718-836-6600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | C1-0011687
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License Number State | DE
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