Healthcare Provider Details

I. General information

NPI: 1649714528
Provider Name (Legal Business Name): MICHELE LUMIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 S 4TH ST
FULTON NY
13069-4905
US

IV. Provider business mailing address

706 S 4TH ST
FULTON NY
13069-4905
US

V. Phone/Fax

Practice location:
  • Phone: 315-887-5250
  • Fax:
Mailing address:
  • Phone: 315-887-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1060548161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: