Provider Demographics
NPI:1942658174
Name:LUGO, FELIPE (MD)
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:LUGO
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:2227 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-4936
Practice Address - Country:US
Practice Address - Phone:863-202-8100
Practice Address - Fax:863-202-8099
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME128127OtherME LICENSE
FL017636500Medicaid
FLME128127OtherME LICENSE
FLME128127OtherME LICENSE
FLIP619ZMedicare PIN
FLIP619YMedicare PIN
FLFL5976228OtherDEA