Provider Demographics
NPI:1134298482
Name:COCCIMIGLIO, LUCY (DO)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:COCCIMIGLIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1602
Mailing Address - Country:US
Mailing Address - Phone:248-674-8530
Mailing Address - Fax:248-674-2198
Practice Address - Street 1:3145 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1602
Practice Address - Country:US
Practice Address - Phone:248-674-8530
Practice Address - Fax:248-674-2198
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011596208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3484033Medicaid
MIG75310Medicare UPIN