Healthcare Provider Details

I. General information

NPI: 1902803067
Provider Name (Legal Business Name): RICHARD M LUCERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY JIM MORAN HEART CENTER, SUITE 502
FORT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

4725 N FEDERAL HWY JIM MORAN HEART CENTER, SUITE 502
FORT LAUDERDALE FL
33308-4603
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-1080
  • Fax: 954-772-7306
Mailing address:
  • Phone: 954-772-1080
  • Fax: 954-772-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME0036746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: