MEDICARE: AARON MICHAEL MITTICA L.AC, DIPL.

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	171100000X	Acupuncturist	AK001092	PA

General Provider Information

NPI Number	:	1104251859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON MICHAEL MITTICA L.AC, DIPL.

Provider Business Mailing Address
First Line	:	45 SCARLET OAK DR
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-2420
Country	:	US
Telephone Number	:	610-761-0528
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 SCARLET OAK DR
Second Line	:
City	:	LAFAYETTE HILL
State	:	PA
Zip	:	19444-2409
Country	:	US
Telephone Number	:	610-825-5282
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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