MEDICARE: CHERYL LUKINS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	4301097135	MI

General Provider Information

NPI Number	:	1013229681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LUKINS M.D.

Provider Business Mailing Address
First Line	:	25 MICHIGAN ST NE STE 2200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2526
Country	:	US
Telephone Number	:	616-391-3245
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MICHIGAN ST NE STE 2200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2526
Country	:	US
Telephone Number	:	616-391-3245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2010
Last Update Date	:	07/11/2010

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