Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 37028 | MN |
Y | 207RC0000X | Internist - Cardiovascular Disease | 37028 | MN |
N | 207RC0200X | Critical Care Medicine | 37028 | MN |
N | 207RI0011X | Interventional Cardiology | 37028 | MN |
NPI | 1073559779 |
---|---|
Provider Name | Michael Joseph Lucca |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805-1951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 20/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
199317800 | (05) | MN |
C18590 | (02) |