Provider Demographics
NPI:1831166305
Name:JUAN FICA, MD, LLC
Entity type:Organization
Organization Name:JUAN FICA, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-753-9313
Mailing Address - Street 1:1389 W MAIN ST
Mailing Address - Street 2:TOWER 2, SUITE 320
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3104
Mailing Address - Country:US
Mailing Address - Phone:203-753-9313
Mailing Address - Fax:203-573-8976
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:TOWER 2, SUITE 320
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-753-9313
Practice Address - Fax:203-573-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT020699207R00000X, 207RE0101X
CT040407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC64866OtherRAILROAD MEDICARE
CTC64866Medicare UPIN
CTC02902Medicare ID - Type Unspecified