MEDICARE: LUCAS KREUTZ RODRIGUES MD

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	208200000X	Plastic Surgery Physician	342045-01	NY
2	208200000X	Plastic Surgery Physician	30735	MN
3	208200000X	Plastic Surgery Physician	70145	MN

General Provider Information

NPI Number	:	1093343212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS KREUTZ RODRIGUES MD

Provider Business Mailing Address
First Line	:	210 E 64TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7471
Country	:	US
Telephone Number	:	212-838-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 E 64TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7471
Country	:	US
Telephone Number	:	212-838-9200
Fax Number	:

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	06/02/2026

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