MEDICARE: MARK A LIVECCHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	130640	FL
2	2081P0004X	Spinal Cord Injury Medicine Physician	130640	FL
3	2081P0301X	Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician	130640	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00884039	OTHER	NY	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043205545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A LIVECCHI MD

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-9092
Fax Number	:	904-244-9493

Provider Business Practice Location Address
First Line	:	15255 MAX LEGGETT PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7273
Country	:	US
Telephone Number	:	904-456-8297
Fax Number	:	904-244-9493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	10/09/2024

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Directions to “ MARK A LIVECCHI MD” Practice Location

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