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NPI Code Detail

MEDICARE: MARK T LUCAS PT

MEDICARE: MARK T LUCAS PT
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
1225100000XPhysical Therapist05007271AIN
2225100000XPhysical Therapist5501303559MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1145210OTHERILMEDICARE GROUP NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21619980OTHERILBCBS OF IL

General Provider Information

NPI Number : 1164545497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK T LUCAS PT
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2771 OAK VALLEY DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-9244
Country : US
Telephone Number : 734-821-7500
Fax Number : 734-821-7501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2007
Last Update Date : 06/30/2025

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Directions to “ MARK T LUCAS PT” Practice Location

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