Provider Demographics
NPI:1326179730
Name:LLOYD AND BOCCACCIO MD PC
Entity Type:Organization
Organization Name:LLOYD AND BOCCACCIO MD PC
Other - Org Name:ST CLAIR SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-647-3924
Mailing Address - Street 1:19229 MACK AVE
Mailing Address - Street 2:SUITE 38
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2858
Mailing Address - Country:US
Mailing Address - Phone:313-885-1520
Mailing Address - Fax:313-647-3995
Practice Address - Street 1:19229 MACK AVE
Practice Address - Street 2:SUITE 38
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2858
Practice Address - Country:US
Practice Address - Phone:313-885-1520
Practice Address - Fax:313-647-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty