Provider Demographics
NPI:1275645962
Name:MICHAEL J DELUCA MD PA
Entity Type:Organization
Organization Name:MICHAEL J DELUCA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-532-2272
Mailing Address - Street 1:PO BOX 12767
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0767
Mailing Address - Country:US
Mailing Address - Phone:915-532-2272
Mailing Address - Fax:915-231-1830
Practice Address - Street 1:1733 CURIE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2910
Practice Address - Country:US
Practice Address - Phone:915-532-2272
Practice Address - Fax:915-231-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7010207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163383602Medicaid
TX163383602Medicaid
TXG37919Medicare UPIN