Provider Demographics
NPI:1235373937
Name:LUCIANO BOEMI, M.D., P.A.
Entity Type:Organization
Organization Name:LUCIANO BOEMI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BOEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-594-9100
Mailing Address - Street 1:11181 HEALTH PARK BLVD STE 1115
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5742
Mailing Address - Country:US
Mailing Address - Phone:239-594-9100
Mailing Address - Fax:239-594-3054
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 1115
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5742
Practice Address - Country:US
Practice Address - Phone:239-594-9100
Practice Address - Fax:239-594-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0075944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG72486Medicare UPIN