MEDICARE: LUCAS MEDICAL LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1134947997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCAS MEDICAL LLC

Provider Business Mailing Address
First Line	:	73 SOWAMS RD
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806-4602
Country	:	US
Telephone Number	:	626-319-5932
Fax Number	:	626-380-2395

Provider Business Practice Location Address
First Line	:	2109 HARTFORD AVE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3246
Country	:	US
Telephone Number	:	626-319-5932
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. BRIAN MIKOLASKO
Credential	:	MD MBA MS
Telephone Number	:	626-319-5932

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	01/26/2026

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Directions to “LUCAS MEDICAL LLC ” Practice Location

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