Provider Demographics
NPI:1962697573
Name:LUKAT, ROY MICHAEL (MED)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:MICHAEL
Last Name:LUKAT
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S HIGHWAY 27
Mailing Address - Street 2:STE. 100
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-3445
Mailing Address - Country:US
Mailing Address - Phone:606-679-3866
Mailing Address - Fax:
Practice Address - Street 1:445 S HIGHWAY 27
Practice Address - Street 2:STE. 100
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-3445
Practice Address - Country:US
Practice Address - Phone:606-679-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0264231H00000X, 231HA2400X, 231HA2500X, 237600000X
KYKY-0691237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500050346Medicaid
KY70000401Medicaid
KYP24575Medicare UPIN
KY70000401Medicaid