Provider Demographics
NPI:1023212990
Name:LUCIANO, AWILDA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:AWILDA
Middle Name:MICHELLE
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 SCRIPTURE STREET
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:940-387-8763
Mailing Address - Fax:940-535-5901
Practice Address - Street 1:2665 SCRIPTURE STREET
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201
Practice Address - Country:US
Practice Address - Phone:940-387-8763
Practice Address - Fax:940-535-5901
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1891207R00000X, 390200000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197184801Medicaid
TXP00716749OtherRAILROAD MEDICARE
TXOTH018Medicare UPIN
TXP00716749OtherRAILROAD MEDICARE