Provider Demographics
NPI:1427056639
Name:LUCCHESE, CHRISTOPHER F (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:F
Last Name:LUCCHESE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0397
Mailing Address - Country:US
Mailing Address - Phone:419-236-2651
Mailing Address - Fax:
Practice Address - Street 1:10935 ESTATE LN STE 395
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5139
Practice Address - Country:US
Practice Address - Phone:972-798-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5843-L208600000X
TXP1784208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2051087Medicaid
TXTXB145799Medicare PIN
OHHO9318291Medicare ID - Type UnspecifiedMEDICARE GROUP
OH2051087Medicaid