MEDICARE: DR. ANDRE ERICH CORREA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	12480	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12480	OTHER	PR	MEDICAL LICENSE

General Provider Information

NPI Number	:	1033166673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE ERICH CORREA M.D.

Provider Business Mailing Address
First Line	:	2306 PARK ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6136
Country	:	US
Telephone Number	:	561-641-6067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 PARK ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6136
Country	:	US
Telephone Number	:	561-641-6067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	06/16/2008

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