MEDICARE: LAURA LUCERO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01060516A	IN

General Provider Information

NPI Number	:	1134111651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LUCERO MD

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:
City	:	DYER
State	:	IN
Zip	:	46311-0800
Country	:	US
Telephone Number	:	219-864-2107
Fax Number	:	219-864-2649

Provider Business Practice Location Address
First Line	:	2001 E COLUMBUS DR
Second Line	:	SUITE C
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2829
Country	:	US
Telephone Number	:	219-933-2623
Fax Number	:	219-378-9284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/08/2007

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