Provider Demographics
NPI:1144328659
Name:SERDOZ, LUCIANO (DPM)
Entity type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:
Last Name:SERDOZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2666
Mailing Address - Country:US
Mailing Address - Phone:304-253-3372
Mailing Address - Fax:304-253-6685
Practice Address - Street 1:100 N HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2666
Practice Address - Country:US
Practice Address - Phone:304-253-3372
Practice Address - Fax:304-253-6685
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV166213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0100191000Medicaid
WV0440662Medicare PIN
WVT32285Medicare UPIN