MEDICARE: LOTUS BLOSSOM CLINIC

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	AP 2473	FL

General Provider Information

NPI Number	:	1588931307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS BLOSSOM CLINIC

Provider Business Mailing Address
First Line	:	6710 WINKLER RD
Second Line	:	SUITE #2
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7274
Country	:	US
Telephone Number	:	239-277-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 WINKLER RD
Second Line	:	SUITE #2
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7274
Country	:	US
Telephone Number	:	239-277-1399
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURE PHYSICIAN
Name	:	DR. DAVID LEE MARTIN
Credential	:	LAC
Telephone Number	:	239-277-1399

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	12/14/2011

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Directions to “LOTUS BLOSSOM CLINIC ” Practice Location

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