MEDICARE: ANNE W LUCKY M.D.

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	208000000X	Pediatrics Physician	35-04-9417	OH
2	207NP0225X	Pediatric Dermatology Physician	35.049417	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285688150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE W LUCKY M.D.

Provider Business Mailing Address
First Line	:	7691 5 MILE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4348
Country	:	US
Telephone Number	:	513-232-3332
Fax Number	:	513-232-9635

Provider Business Practice Location Address
First Line	:	7691 5 MILE RD
Second Line	:	STE. 312
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4348
Country	:	US
Telephone Number	:	513-232-3332
Fax Number	:	513-232-9635

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/05/2020

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Directions to “ ANNE W LUCKY M.D.” Practice Location

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