Provider Demographics
NPI:1912726217
Name:LUCAS, MAURICE W JR
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:W
Last Name:LUCAS
Suffix:JR
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 1:9359 VAUGHAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-1683
Mailing Address - Country:US
Mailing Address - Phone:313-610-5558
Mailing Address - Fax:
Practice Address - Street 1:9359 VAUGHAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-1683
Practice Address - Country:US
Practice Address - Phone:313-610-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL220590870917374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide