MEDICARE: LIFETIME MEDICAL ASSOCIATES, P.C.

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174544050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME MEDICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E STE 250
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6123
Country	:	US
Telephone Number	:	248-293-1002
Fax Number	:	248-293-1272

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E STE 250
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6123
Country	:	US
Telephone Number	:	248-293-1002
Fax Number	:	248-293-1272

Authorized Official
Title or Position	:	BILLING
Name	:	MRS. MELISSA MEAD
Credential	:
Telephone Number	:	248-293-1002

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	10/28/2008

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