Provider Demographics
NPI:1033191150
Name:FUCICH, LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:FUCICH
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:PO BOX 91498
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-1498
Mailing Address - Country:US
Mailing Address - Phone:251-460-0326
Mailing Address - Fax:251-460-2846
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-460-0326
Practice Address - Fax:251-460-2846
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20718207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912217Medicaid
AL009939717Medicaid
AL000035764Medicare PIN
AL009912217Medicaid