MEDICARE: DR. LUCIANO LIZZI M.D., J.D.

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	2084P0800X	Psychiatry Physician	MD026410E	PA

General Provider Information

NPI Number	:	1225197452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIANO LIZZI M.D., J.D.

Provider Business Mailing Address
First Line	:	4830 INNISBROOK CT APT 1003
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6609
Country	:	US
Telephone Number	:	610-896-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 INNISBROOK CT APT 1003
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6609
Country	:	US
Telephone Number	:	610-896-8580
Fax Number	:

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	01/27/2023

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