Healthcare Provider Details

I. General information

NPI: 1437100799
Provider Name (Legal Business Name): LUCIO GIOVANNI PALANCA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 N 1000 W
LINTON IN
47441-5282
US

IV. Provider business mailing address

1542 S BLOOMINGTON ST STE 1100
GREENCASTLE IN
46135
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-2281
  • Fax: 812-847-5238
Mailing address:
  • Phone: 765-658-2710
  • Fax: 765-653-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01060122A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: