Provider Demographics
NPI:1750330650
Name:LUCE, PAUL A (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:LUCE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:245 CHERRY ST SE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4607
Mailing Address - Country:US
Mailing Address - Phone:616-459-4131
Mailing Address - Fax:616-459-6030
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:SUITE 302
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-459-4131
Practice Address - Fax:616-459-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010619832086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4075832Medicaid
MIG90379Medicare UPIN
MIOD16253008Medicare ID - Type Unspecified