Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 62251 | MN |
Y | 208600000X | Surgeon | 62251 | MN |
NPI | 1003170424 |
---|---|
Provider Name | Dustin Dean Lucarelli |
First Address | Duluth, MN 55805-2201 |
Second Address | Duluth, MN 55805-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 04/12/2020 |