Individual
TYLER JACOB LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
301 SATORI PKWY STE 120, AVON, IN 46123-6407
(317) 718-4263
(317) 272-7855
Mailing address
301 SATORI PKWY STE 120, AVON, IN 46123-6407
(317) 718-4863
(317) 272-7855
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11019906A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02006385A
IN
Other
Enumeration date
04/11/2018
Last updated
08/19/2022
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