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General NPI Number Information
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NPI Number | 1861345308
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Entity Type | Individual
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Provider Name | CAMERON LUCAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1095 MEDICAL PARK DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3685
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Country | US
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Telephone | 616-949-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 287 TIMBER CREEK CIR NW
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City | COMSTOCK PARK
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State | MI
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Zip | 49321-8569
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601013613
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License Number State | MI
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