MEDICARE: VICTOR C. MICOLUCCI 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	207Q00000X	Family Medicine Physician	ME47620	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	KP219	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	59980	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568487478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR C. MICOLUCCI M.D.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	11513 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4002
Country	:	US
Telephone Number	:	904-751-6200
Fax Number	:	904-751-1600

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/28/2020

Similar Medicare Providers

1306122973 — MR. WEIDONG SU PA-C
Practice Location Address:

11565 N MAIN ST
JACKSONVILLE, FL
32218-4002

Practice Phone: 904-757-2811
Practice Fax: 904-757-0191

1326046350 — DR. IRIS EISENBERG MD
Practice Location Address:

11521 N MAIN ST
JACKSONVILLE, FL
32218-4002

Practice Phone: 904-751-9491
Practice Fax: 904-751-9492

1538146048 — PATRICK DEVERELL BIANCHI
Practice Location Address:

11513 N MAIN ST
JACKSONVILLE, FL
32218-4002

Practice Phone: 904-751-6200
Practice Fax:

1699790675 — MR. OLAN T. MCFERRIN PA
Practice Location Address:

11513 N MAIN ST
JACKSONVILLE, FL
32218-4002

Practice Phone: 904-751-6200
Practice Fax: 904-751-1600

1306861240 — BURTON H. MENDEL PA
Practice Location Address:

11513 N MAIN ST
JACKSONVILLE, FL
32218-4002

Practice Phone: 904-751-6200
Practice Fax: 904-751-1600

1245255199 — OCEANWAY MEDICAL CENTER, INC.
Practice Location Address:

11513 N MAIN ST
JACKSONVILLE, FL
32218-4002

Practice Phone: 904-751-6200
Practice Fax: 904-751-1600

Directions to “ VICTOR C. MICOLUCCI M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.