MEDICARE: JOSEPH LUKASKA

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	207Q00000X	Family Medicine Physician	N8029	TX

General Provider Information

NPI Number	:	1265416895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH LUKASKA

Provider Business Mailing Address
First Line	:	2950 W CAMP WISDOM RD STE 100
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4461
Country	:	US
Telephone Number	:	972-602-4466
Fax Number	:	972-602-4471

Provider Business Practice Location Address
First Line	:	2950 W CAMP WISDOM RD STE 100
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4461
Country	:	US
Telephone Number	:	972-602-4466
Fax Number	:	972-602-4471

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	08/14/2014

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