Provider Demographics
NPI:1003969445
Name:MICHAEL J. LUCHERINI MDPC
Entity Type:Organization
Organization Name:MICHAEL J. LUCHERINI MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TWEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-792-1080
Mailing Address - Street 1:6828 E BROWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3761
Mailing Address - Country:US
Mailing Address - Phone:480-981-8650
Mailing Address - Fax:480-981-1563
Practice Address - Street 1:6828 E BROWN RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3761
Practice Address - Country:US
Practice Address - Phone:480-981-8650
Practice Address - Fax:480-981-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ364076Medicaid
AZ364076Medicaid