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NPI Code Detail

MEDICARE: MR. GREGORY LUKOWSKI SURGICAL ASSIST

MEDICARE: MR. GREGORY LUKOWSKI SURGICAL ASSIST
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1366924227
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY LUKOWSKI SURGICAL ASSIST
Provider Business Mailing Address
First Line : 324 OAK MEADOWS DR
Second Line :
City : WOOD DALE
State : IL
Zip : 60191-2259
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 BIESTERFIELD RD
Second Line :
City : ELK GROVE VLG
State : IL
Zip : 60007-3361
Country : US
Telephone Number : 847-437-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 09/06/2018

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