Provider Demographics
NPI:1275517690
Name:BELNICK, LUCILLE B (MD)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:B
Last Name:BELNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5474 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32707
Mailing Address - Country:US
Mailing Address - Phone:407-679-3400
Mailing Address - Fax:407-679-3412
Practice Address - Street 1:5478 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1034
Practice Address - Country:US
Practice Address - Phone:407-679-3400
Practice Address - Fax:407-679-3412
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375262300Medicaid
FL375262300Medicaid
FLE44222Medicare UPIN
FL25153YMedicare PIN