MEDICARE: DR. LISA MARIE LUCAS 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	208D00000X	General Practice Physician	38995	CO

General Provider Information

NPI Number	:	1881753143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE LUCAS M.D.

Provider Business Mailing Address
First Line	:	3525 W OXFORD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3127
Country	:	US
Telephone Number	:	303-866-7050
Fax Number	:	303-866-7053

Provider Business Practice Location Address
First Line	:	3525 W OXFORD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3127
Country	:	US
Telephone Number	:	303-866-7755
Fax Number	:	303-866-7053

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	02/25/2010

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