Provider Demographics
NPI:1659785392
Name:LUCERO, JUAN AURELIO (LMT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:AURELIO
Last Name:LUCERO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2489
Mailing Address - Country:US
Mailing Address - Phone:734-397-6115
Mailing Address - Fax:734-397-6116
Practice Address - Street 1:4101 S CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2489
Practice Address - Country:US
Practice Address - Phone:734-397-6115
Practice Address - Fax:734-397-6116
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator