Provider Demographics
NPI:1437100799
Name:PALANCA, LUCIO GIOVANNI (MD)
Entity type:Individual
Prefix:
First Name:LUCIO
Middle Name:GIOVANNI
Last Name:PALANCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 S BLOOMINGTON ST
Mailing Address - Street 2:STE 1100
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135
Mailing Address - Country:US
Mailing Address - Phone:765-658-2710
Mailing Address - Fax:765-653-8686
Practice Address - Street 1:1185 N 1000 W
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5282
Practice Address - Country:US
Practice Address - Phone:812-847-2281
Practice Address - Fax:812-847-5238
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060122A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200515150AMedicaid
IN000000368575OtherANTHEM
INI29061Medicare UPIN