Provider Demographics
NPI:1780762724
Name:LUKASIEWICZ, CYNTHIA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:LUKASIEWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7050 WINKLER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-985-9518
Mailing Address - Fax:239-985-9546
Practice Address - Street 1:7050 WINKLER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-985-9518
Practice Address - Fax:239-985-9546
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010681207Q00000X
FLOS0006393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1780762724Medicare NSC
FL1356538052Medicare NSC
FLF41837Medicare UPIN
80717ZMedicare PIN
FL39472Medicare PIN