Basic Information
| Provider Information | |||||||||
| NPI: | 1154769545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYC | ||||||||
| FirstName: | LUKASZ | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 5955 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366083135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2013 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101260427 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 40964 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101260427 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RP1001X | 40964 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | ZZ2155 | 01 | AL | VIVA HEALTH | OTHER | 251324 | 05 | AL | MEDICAID | 251328 | 05 | AL | MEDICAID | 253074 | 05 | AL | MEDICAID | 251338 | 05 | AL | MEDICAID | 4150261 | 01 | AL | AETNA | OTHER | 512-44737 | 01 | AL | BCBS | OTHER | P02511079 | 01 | AL | RR MEDICARE | OTHER | 512-44735 | 01 | AL | BCBS | OTHER | 6099394 | 01 | AL | UHC | OTHER | A10255A | 01 | AL | MEDICARE | OTHER | 512-44736 | 01 | AL | BCBS | OTHER | 02739713 | 05 | MS | MEDICAID | 512-44734 | 01 | AL | BCBS | OTHER |