Provider Demographics
NPI:1912916495
Name:DELUCA, LOUIS STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:STEVEN
Last Name:DELUCA
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 1:1905 CLINT MOORE RD
Mailing Address - Street 2:STE 303
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:561-998-3333
Mailing Address - Fax:561-353-1583
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:STE 303
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496
Practice Address - Country:US
Practice Address - Phone:561-998-3333
Practice Address - Fax:561-353-1583
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076256208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49782OtherBC/BS
FL49782OtherBC/BS
G99491Medicare UPIN