Provider Demographics
NPI:1457409187
Name:MILAN-LUCCA, JUAN (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:MILAN-LUCCA
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:PO BOX 29707
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0707
Mailing Address - Country:US
Mailing Address - Phone:787-768-8921
Mailing Address - Fax:787-740-1051
Practice Address - Street 1:BAYAMON MEDICAL PLAZA , ROAD 2
Practice Address - Street 2:SUITE 409-A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0000
Practice Address - Country:US
Practice Address - Phone:787-740-1051
Practice Address - Fax:787-740-1051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10217207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF74007Medicare UPIN