Healthcare Provider Details

I. General information

NPI: 1558330217
Provider Name (Legal Business Name): ERIC I MUCA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LINCOLN ST
SACO ME
04072-3113
US

IV. Provider business mailing address

333 LINCOLN ST
SACO ME
04072-3113
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-6330
  • Fax: 207-283-3338
Mailing address:
  • Phone: 207-282-6330
  • Fax: 207-283-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD1025
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: