Provider Demographics
NPI:1295796902
Name:SALUCK, BRIAN HARRIS (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:HARRIS
Last Name:SALUCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-5038
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:BUILDING 210
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5604
Practice Address - Country:US
Practice Address - Phone:352-751-3356
Practice Address - Fax:352-751-3359
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010773L207RI0011X
FLOS11546207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065254Medicare ID - Type Unspecified
H76884Medicare UPIN