Provider Demographics
NPI:1407891294
Name:LUKASIK, LAUREN G (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:G
Last Name:LUKASIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:G
Other - Last Name:PAKOSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2109 HUGHES DR # 760
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3858
Practice Address - Country:US
Practice Address - Phone:419-291-2671
Practice Address - Fax:419-291-2680
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002266363A00000X
OH50003243363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002266OtherSTATE LICENSE AS A PA
OH0074794Medicaid