Provider Demographics
NPI:1447322367
Name:LUCHANSKY, MITCHELL ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ALAN
Last Name:LUCHANSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 OLD MOODY BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2470
Mailing Address - Country:US
Mailing Address - Phone:386-313-5752
Mailing Address - Fax:386-313-5801
Practice Address - Street 1:267 OLD MOODY BLVD
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2470
Practice Address - Country:US
Practice Address - Phone:386-313-5752
Practice Address - Fax:386-313-5801
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG555272084P0804X
FLME775302084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015704300Medicaid