1508115817 NPI number — RICHALY LUCE

Table of content: DR. ALMAS A MECKLAI M.D.,M.B.A., (NPI 1588664023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508115817 NPI number — RICHALY LUCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCE
Provider First Name:
RICHALY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508115817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 S MONROE AVE STE 106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54301-4054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-544-0346
Provider Business Mailing Address Fax Number:
920-489-8233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 S MONROE AVE STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301-4054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-544-0346
Provider Business Practice Location Address Fax Number:
920-489-8233
Provider Enumeration Date:
08/31/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  1003719 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 703436 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)