Individual
LUBOMYR DOMASHEVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 PORT WASHINGTON RD, GRAFTON, WI 53024-9201
(262) 329-1900
Mailing address
975 PORT WASHINGTON RD, GRAFTON, WI 53024-9201
(262) 329-1900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
47504-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34643000
—
WI
01
—
P00240569
MEDICARE RAILROAD
WI
01
—
P00273830
MEDICARE RAILROAD
WI
Enumeration date
05/12/2006
Last updated
12/28/2021
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