Individual
LUCAS PETTIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8003 BREWERTON RD, CICERO, NY 13039-9528
(315) 288-4006
(315) 288-4760
Mailing address
3292 BLACK ST, SCIPIO CENTER, NY 13147-3172
(315) 406-6385
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/08/2016
Last updated
12/03/2019
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