MEDICARE: DR. MITCHELL ALAN LUCHANSKY M.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	2084P0804X	Child & Adolescent Psychiatry Physician	G55527	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME77530	FL

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	:	1447322367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL ALAN LUCHANSKY M.D.

Provider Business Mailing Address
First Line	:	267 OLD MOODY BLVD
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2470
Country	:	US
Telephone Number	:	386-313-5752
Fax Number	:	386-313-5801

Provider Business Practice Location Address
First Line	:	267 OLD MOODY BLVD
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2470
Country	:	US
Telephone Number	:	386-313-5752
Fax Number	:	386-313-5801

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/22/2024

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