MEDICARE: LC HEALTH MANAGEMENT LLC

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME93736	OTHER	FL	MD LICENSE

General Provider Information

NPI Number	:	1528439080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LC HEALTH MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	8200 SW 117TH AVE
Second Line	:	SUITE 112
City	:	MIAMI
State	:	FL
Zip	:	33183-3856
Country	:	US
Telephone Number	:	305-596-7432
Fax Number	:

Provider Business Practice Location Address
First Line	:	14788 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4070
Country	:	US
Telephone Number	:	786-272-9170
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	LUIS PENATE-PEREZ
Credential	:
Telephone Number	:	305-596-7432

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	02/08/2023

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Directions to “LC HEALTH MANAGEMENT LLC ” Practice Location

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