Lucas W Maliwacki, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9108377 Issued in FL

Practice address

4647 Manatee Ave W
Bradenton, FL 34209-3816

Phone

(941) 745-5999

Fax

(941) 745-3555

NPI assigned

Oct 28, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Em Alliance LLC

  • Emergency Medicine Physician
  • Wellington, FL
  • NPI 1922788959
  Medicare reassignment
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment
• FL-I Medical Services, LLC

  • Nurse Practitioner
  • Fort Pierce, FL
  • NPI 1750655106
  Medicare reassignment
• FL - I Medical Services LLC

  • Nurse Practitioner
  • Aventura, FL
  • NPI 1275808701

  Physician Assistant

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506470400000",
    "number": "1194120535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 S. GULPH RD",
            "address_2": "ATT: IPM CREDENTIALING",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063121",
            "telephone_number": "775-356-9393",
            "fax_number": "775-356-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4647 MANATEE AVE W",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342093816",
            "telephone_number": "941-745-5999",
            "fax_number": "941-745-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALIWACKI",
        "first_name": "LUCAS",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-28",
        "last_updated": "2017-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108377",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dianne Malave
• Orlando Maldonado, M.D.
• Sebastian Maletz
• Aisha Mohsin Malik, M.D.
• Rajesh Malik, M.D.
• Loretta R Mallari, ARNP
• George Darren Malone, PHARMD.
• Malooka Pharma Corp
• Mana Care, LLC
• Manasota Accident & Injury Center, LLC

• Physician Assistant in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.