Provider Demographics
NPI:1669493599
Name:CURA-LUKICH, MIRTA B (MD)
Entity Type:Individual
Prefix:MRS
First Name:MIRTA
Middle Name:B
Last Name:CURA-LUKICH
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 1:1412 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3524
Mailing Address - Country:US
Mailing Address - Phone:352-787-1324
Mailing Address - Fax:352-365-1003
Practice Address - Street 1:802 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6014
Practice Address - Country:US
Practice Address - Phone:352-787-1324
Practice Address - Fax:352-365-1003
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG93591Medicare UPIN
FLE2547YMedicare ID - Type Unspecified