Provider Demographics
NPI:1316911498
Name:LULEK, JAMES RANDOLPH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDOLPH
Last Name:LULEK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18181 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-5032
Mailing Address - Country:US
Mailing Address - Phone:313-271-8560
Mailing Address - Fax:313-271-2831
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-271-8560
Practice Address - Fax:313-271-2831
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035314208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1343439Medicaid
MI020H263670OtherBCBSM GROUP PIN#
MI02-0820266-2OtherBCBSM INDIVIDUAL PIN#
MIB6130OtherMCARE INDIVIDUAL PIN#
MIA73926Medicare UPIN
MIB6130OtherMCARE INDIVIDUAL PIN#