Healthcare Provider Details

I. General information

NPI: 1205548450
Provider Name (Legal Business Name): BIOCORE THERAPEUTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W SMITH ST
WINTER GARDEN FL
34787-3582
US

IV. Provider business mailing address

29 W SMITH ST
WINTER GARDEN FL
34787-3582
US

V. Phone/Fax

Practice location:
  • Phone: 407-307-1510
  • Fax:
Mailing address:
  • Phone: 407-307-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER WAYNE LUCZYWO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 407-307-1511