Individual
LUCAS M MIRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4100 DEWEY ST, MANITOWOC, WI 54220-5497
(920) 686-5700
(920) 684-2936
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
82032
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100385175
—
WI
Enumeration date
04/22/2022
Last updated
11/17/2025
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