Provider Demographics
NPI:1699776351
Name:LUKOWSKI, PETER JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:LUKOWSKI
Suffix:
Gender:M
Credentials:MD
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 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7162
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3980 HIGHWAY 9 E
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8163
Practice Address - Country:US
Practice Address - Phone:843-390-0100
Practice Address - Fax:843-390-0038
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-10-16
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
SC11728207X00000X
NC200200401207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0009333000Medicaid
9223731Medicare PIN
P00607634Medicare PIN