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General NPI Number Information
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NPI Number | 1699909747
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Entity Type | Organization
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Legal Business Name | MICHAEL W. LUCARELLI D.O.,INC.
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 3461 S COUNTY TRL SUITE 201
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1463
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Country | US
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Telephone | 401-471-6850
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Fax | 401-471-6855
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Provider Business Mailing Address
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Address Line | 3461 S COUNTY TRL SUITE 201
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1463
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Country | US
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Telephone | 401-471-6850
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Fax | 401-471-6855
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. MICHAEL WILLIAM LUCARELLI
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Credential | D.O.
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Telephone | 401-471-6850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DO00491
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License Number State | RI
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