MEDICARE: MICHELE BOURGOUIN A.P.

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	AP2457	FL

General Provider Information

NPI Number	:	1316136864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE BOURGOUIN A.P.

Provider Business Mailing Address
First Line	:	1925 HARRISON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5017
Country	:	US
Telephone Number	:	844-325-9466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 HARRISON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5017
Country	:	US
Telephone Number	:	844-325-9466
Fax Number	:

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/30/2014

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