Provider Demographics
NPI:1952361891
Name:ERIC J LULLOVE DPM PA
Entity Type:Organization
Organization Name:ERIC J LULLOVE DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LULLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-989-9780
Mailing Address - Street 1:4855 W HILLSBORO BLVD STE B6
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4356
Mailing Address - Country:US
Mailing Address - Phone:561-989-9780
Mailing Address - Fax:561-989-9781
Practice Address - Street 1:4855 W HILLSBORO BLVD STE B6
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4356
Practice Address - Country:US
Practice Address - Phone:561-989-9780
Practice Address - Fax:561-989-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3133213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340480300Medicaid
FL5530250001Medicare NSC
K8687Medicare PIN
FL340480300Medicaid