Basic Information
| Provider Information | |||||||||
| NPI: | 1679816813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | CREA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3333 BURNET AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136364200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 ROSE ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405363026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592182581 | ||||||||
| FaxNumber: | 8592571632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2013 | ||||||||
| LastUpdateDate: | 06/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LH0002X | 34.014503 | OH | N | Allopathic & Osteopathic Physicians | Anesthesiology | Hospice and Palliative Medicine | 208000000X | 63288-21 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080H0002X | 05259 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1679816813 | 05 | WI | MEDICAID |