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General NPI Number Information
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NPI Number | 1073194320
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Entity Type | Individual
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Provider Name | MICHAEL LOUIS LUCCHESI
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Gender | Male
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 3219 170TH AVE E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-5530
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Country | US
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Telephone | 253-363-6207
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Fax |
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Provider Business Mailing Address
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Address Line | 3219 170TH AVE E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-5530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9115677
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License Number State | FL
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