Provider Demographics
NPI:1790747806
Name:NUCHOVICH, DANIEL IGAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:IGAL
Last Name:NUCHOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 TONEY PENNA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5755
Mailing Address - Country:US
Mailing Address - Phone:561-746-2033
Mailing Address - Fax:561-744-5349
Practice Address - Street 1:175 TONEY PENNA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5755
Practice Address - Country:US
Practice Address - Phone:561-746-2033
Practice Address - Fax:561-744-5349
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0053694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09272OtherBLUE CROSS BLUE SHIELD
FLC52001Medicare UPIN
FL09272Medicare ID - Type Unspecified