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Organization
W.D.LUCKY, M.D., INC
Active
Organization
W.D.LUCKY, M.D., INC
Active
Other names
W.D. Lucky, M.D., Inc
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM DAVID LUCKY M.D. (PRESIDENT)
(305) 238-3990
Entity
Organization
Contact information
Practice address
13520 SW 152ND ST, #771834, MIAMI, FL 33177-0031
(305) 238-3990
Mailing address
13520 SW 152ND ST, #771834, MIAMI, FL 33177-0031
(305) 238-3990
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0029049
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038136500
—
FL
01
—
95193Y
FL MEDICARE INDIVIDUAL PTAN
FL
Enumeration date
06/27/2006
Last updated
01/05/2015
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