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NPI Code Detail

MEDICARE: SONY LUKOSE

MEDICARE: SONY LUKOSE
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
1261QP2000XPhysical Therapy Clinic/Center5501016122MI

General Provider Information

NPI Number : 1174028781
Entity Type Code : Individual
Provider Name (Legal Business Name) : SONY LUKOSE
Provider Business Mailing Address
First Line : 34542 HEARTSWORTH LN
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48312-5739
Country : US
Telephone Number : 248-747-2181
Fax Number :
Provider Business Practice Location Address
First Line : 21401 MACK AVE
Second Line :
City : GROSSE POINTE WOODS
State : MI
Zip : 48236-1048
Country : US
Telephone Number : 586-778-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2018
Last Update Date : 03/26/2018

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Directions to “ SONY LUKOSE ” Practice Location

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