Provider Demographics
NPI:1225007669
Name:FLORES, LUCKY (MD)
Entity Type:Individual
Prefix:
First Name:LUCKY
Middle Name:
Last Name:FLORES
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 1:1750 W 46TH ST APT 439
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2877
Mailing Address - Country:US
Mailing Address - Phone:305-801-6671
Mailing Address - Fax:
Practice Address - Street 1:1140 W 50TH ST STE 301
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3411
Practice Address - Country:US
Practice Address - Phone:305-827-0208
Practice Address - Fax:305-827-0280
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75421207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4489AMedicare ID - Type Unspecified
FLH23484Medicare UPIN