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General NPI Number Information
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NPI Number | 1528696788
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Entity Type | Individual
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Provider Name | LUCAS AUGUSTO HELDT MANICA MD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 301 MEMORIAL MEDICAL PKWY
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5167
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Country | US
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Telephone | 386-231-3147
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Fax | 386-231-3695
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Provider Business Mailing Address
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Address Line | PO BOX 935921
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City | ATLANTA
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State | GA
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Zip | 31193-5921
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 69588
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30853
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME166558
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License Number State | FL
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