Provider Demographics
NPI:1033163217
Name:DELUCCA, LEOPOLDO E (MD)
Entity Type:Individual
Prefix:DR
First Name:LEOPOLDO
Middle Name:E
Last Name:DELUCCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-576-5000
Mailing Address - Fax:515-576-7869
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-576-5000
Practice Address - Fax:515-576-7869
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22366207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1189068Medicaid
IAI18673Medicare PIN
IA1189068Medicaid