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Individual

DAN S SCIUCA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1659 TRAIL RIDGE AVE, PORTAGE, MI 49024
(269) 998-5398
Mailing address
1659 TRAIL RIDGE AVE, PORTAGE, MI 49024-4900
(269) 998-5398
(269) 341-7781

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301078831
MI
208M00000X
Hospitalist Physician
Primary
4301078831
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0G56008
MEDICARE GROUP
MI
01
1107500612
BCBS PIN
MI
01
143068
GREAT LAKES HEALTH PLAN-T
MI
01
382317300 107
COMM CHOICE MI-WP
MI
01
382317300 140
COMM CHOICE MI-IM
MI
01
382317300 154
COMM CHOICE MI-TR
MI
05
4347244 10
MI
05
4460009 10
MI
05
4601303 10
MI
05
4848285
MI
05
4938130 10
MI
01
700G560080
BCBS GROUP
MI
Enumeration date
11/16/2005
Last updated
04/28/2021
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