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NPI Code Detail

MEDICARE: LUCIAN I. LUPAS PA-C

MEDICARE: LUCIAN I. LUPAS PA-C
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
1363A00000XPhysician Assistant1139591MI

General Provider Information

NPI Number : 1891255998
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCIAN I. LUPAS PA-C
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4600 INVESTMENT DR STE 200
Second Line :
City : TROY
State : MI
Zip : 48098-6375
Country : US
Telephone Number : 248-267-5050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2019
Last Update Date : 05/19/2026

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Directions to “ LUCIAN I. LUPAS PA-C” Practice Location

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