MEDICARE: YELIU IRISH LMT

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	174400000X	Specialist	MA48224	FL

General Provider Information

NPI Number	:	1134261225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELIU IRISH LMT

Provider Business Mailing Address
First Line	:	1542 HWY389
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-0000
Country	:	US
Telephone Number	:	850-747-1444
Fax Number	:	850-747-1444

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE STE A
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4551
Country	:	US
Telephone Number	:	850-747-1444
Fax Number	:	850-747-1444

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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Directions to “ YELIU IRISH LMT” Practice Location

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