Provider Demographics
NPI:1851048177
Name:TORRES, LUKAS DAVID
Entity type:Individual
Prefix:
First Name:LUKAS
Middle Name:DAVID
Last Name:TORRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 S HOWELL AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1460
Mailing Address - Country:US
Mailing Address - Phone:262-476-4900
Mailing Address - Fax:
Practice Address - Street 1:7003 S HOWELL AVE STE 1600
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-1460
Practice Address - Country:US
Practice Address - Phone:262-476-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7033-23202K00000X
WI7033363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty