Individual
MELISSA ELAINE LUCARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
504 S HIGH STREET, RANDOLPH, WI 53956
(920) 326-5060
(920) 326-5061
Mailing address
504 S HIGH ST, PO BOX 101, RANDOLPH, WI 53956-1499
(920) 326-5060
(920) 326-5061
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36988020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080174465
RAILROAD MEDICARE
—
01
—
11573
DEAN HEALTH PLAN
WI
05
—
32327000
—
WI
Enumeration date
04/11/2006
Last updated
07/13/2010
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