Provider Demographics
NPI:1639275084
Name:AVARICIO, MICHAEL LUZ (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LUZ
Last Name:AVARICIO
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 1:9511 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2500
Mailing Address - Country:US
Mailing Address - Phone:718-360-5060
Mailing Address - Fax:718-323-1105
Practice Address - Street 1:9511 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2500
Practice Address - Country:US
Practice Address - Phone:718-360-5060
Practice Address - Fax:718-323-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME165993207R00000X, 207RC0000X
NY222928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1639275084OtherNPI
NY02769602Medicaid