Healthcare Provider Details

I. General information

NPI: 1235373937
Provider Name (Legal Business Name): LUCIANO BOEMI, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11181 HEALTH PARK BLVD STE 1115
NAPLES FL
34110-5742
US

IV. Provider business mailing address

11181 HEALTH PARK BLVD STE 1115
NAPLES FL
34110-5742
US

V. Phone/Fax

Practice location:
  • Phone: 239-594-9100
  • Fax: 239-594-3054
Mailing address:
  • Phone: 239-594-9100
  • Fax: 239-594-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 0075944
License Number StateFL

VIII. Authorized Official

Name: MRS. CASSIE JANE BOEMI
Title or Position: VICE PRESIDENT
Credential:
Phone: 239-594-9100