Provider Demographics
NPI:1427155639
Name:LEOPOLDO E DELUCCA MD PC
Entity type:Organization
Organization Name:LEOPOLDO E DELUCCA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELUCCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-576-5000
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5744
Mailing Address - Country:US
Mailing Address - Phone:515-576-5000
Mailing Address - Fax:515-576-7869
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5744
Practice Address - Country:US
Practice Address - Phone:515-576-5000
Practice Address - Fax:515-576-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22366207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA02950Medicare UPIN