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Individual

MR. LUKAS WARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0479
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007287
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
214881
MULTI SPECIALTY GROUP PTAN
IL
Enumeration date
09/18/2019
Last updated
03/13/2025
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