MEDICARE: DR. LIONEL LUGO M.D.

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	174400000X	Specialist	6465	PA

General Provider Information

NPI Number	:	1164423828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIONEL LUGO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1063
Second Line	:
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-1063
Country	:	US
Telephone Number	:	787-848-4777
Fax Number	:	787-848-4777

Provider Business Practice Location Address
First Line	:	HOSPITAL SAN LUCAS I
Second Line	:	CALLE GUADALUPE FINAL - BOX 2027
City	:	PONCE
State	:	PR
Zip	:	00731
Country	:	US
Telephone Number	:	787-848-4777
Fax Number	:	787-848-4777

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	05/13/2019

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