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NPI Code Detail

MEDICARE: DR. SOPHIE ALEXANDRA LUKASHOK MD

MEDICARE: DR. SOPHIE ALEXANDRA LUKASHOK MD
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
1207RI0200XInfectious Disease Physician044010GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22528447OTHERGAAETNA HEALTHCARE

General Provider Information

NPI Number : 1417901653
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SOPHIE ALEXANDRA LUKASHOK MD
Provider Business Mailing Address
First Line : 3495 PIEDMONT RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30305-1717
Country : US
Telephone Number : 404-365-0966
Fax Number :
Provider Business Practice Location Address
First Line : 735 PIEDMONT AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30308-1416
Country : US
Telephone Number : 404-588-4680
Fax Number : 404-588-4692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 01/13/2022

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