Provider Demographics
NPI:1588780662
Name:LUCCO, KERITH LUCIA (MD)
Entity type:Individual
Prefix:DR
First Name:KERITH
Middle Name:LUCIA
Last Name:LUCCO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1110 HIGHLANDS PLAZA DR E STE 280
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1351
Mailing Address - Country:US
Mailing Address - Phone:314-286-2620
Mailing Address - Fax:314-286-2621
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E STE 280
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1351
Practice Address - Country:US
Practice Address - Phone:314-286-2620
Practice Address - Fax:314-286-2621
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA102817207V00000X
MO2017016282207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology