Provider Demographics
NPI:1205548450
Name:BIOCORE THERAPEUTICS, LLC
Entity type:Organization
Organization Name:BIOCORE THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LUCZYWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-307-1511
Mailing Address - Street 1:1616 S TANNER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-2791
Mailing Address - Country:US
Mailing Address - Phone:216-570-6083
Mailing Address - Fax:
Practice Address - Street 1:1002 S DILLARD ST STE 114
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-307-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service