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General NPI Number Information
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NPI Number | 1932737053
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Entity Type | Individual
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Provider Name | ALLISON DANA MIKA LUKACIC DO
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 1353 DORCHESTER AVE
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City | DORCHESTER
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State | MA
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Zip | 02122-2932
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Country | US
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Telephone | 617-288-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE STE 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone | 617-414-5405
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1021310
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License Number State | MA
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