Provider Demographics
NPI:1508063124
Name:LUCIC, ANDREW PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PATRICK
Last Name:LUCIC
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 1:1646 SETTLERS RESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2041
Mailing Address - Country:US
Mailing Address - Phone:330-322-4043
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC FDTN
Practice Address - Street 2:9500 EUCLID AVE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN # 11440207L00000X
OH35.098660207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11440OtherTRN- TRAINING LICENSE
OH35.098660OtherSTATE LICENSE