MEDICARE: PHILIP LEE LAC

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	3440	FL

General Provider Information

NPI Number	:	1528470622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP LEE LAC

Provider Business Mailing Address
First Line	:	1507 E LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 E LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2345
Country	:	US
Telephone Number	:	786-505-9692
Fax Number	:

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

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	05/22/2014

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Directions to “ PHILIP LEE LAC” Practice Location

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