Individual
ALPHONSE DELUCIA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 740-5293
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
053184
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
4301053184
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03904931
BLUE CROSS BLUE SHIELD
MI
01
—
1417961137
BCBSM - BRONSON
MI
05
—
1588612345
—
MI
05
—
4211999
—
MI
Enumeration date
05/04/2006
Last updated
08/25/2023
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