Provider Demographics
NPI:1962559807
Name:LUCA, MICHAEL J (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LUCA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:257 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2606
Mailing Address - Country:US
Mailing Address - Phone:828-258-1121
Mailing Address - Fax:828-252-6114
Practice Address - Street 1:257 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2606
Practice Address - Country:US
Practice Address - Phone:828-258-1121
Practice Address - Fax:828-252-6114
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102102363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901940Medicaid
NC780000898OtherRAILROAD MEDICARE
NC780000898OtherRAILROAD MEDICARE
NC2743547Medicare ID - Type Unspecified