=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235373937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCIANO BOEMI, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2009
-----------------------------------------------------
Last Update Date | 04/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11181 HEALTH PARK BLVD STE 1115
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-5742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-594-9100
-----------------------------------------------------
Fax | 239-594-3054
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11181 HEALTH PARK BLVD STE 1115
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-5742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-594-9100
-----------------------------------------------------
Fax | 239-594-3054
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. CASSIE JANE BOEMI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-594-9100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME 0075944
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------