MEDICARE: LAURA M GARLISI MD

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	2084P0800X	Psychiatry Physician	ME35400	FL

General Provider Information

NPI Number	:	1194810333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M GARLISI MD

Provider Business Mailing Address
First Line	:	9269 MENTOR RD
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-8604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 S STATE ST
Second Line	:	#204
City	:	PAINESVILLE
State	:	OH
Zip	:	44077-3445
Country	:	US
Telephone Number	:	440-357-6740
Fax Number	:	440-350-0506

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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