MEDICARE: DR. JACK MICHAEL LOMANO 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	207VG0400X	Gynecology Physician	ME 33323	FL

General Provider Information

NPI Number	:	1629380076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK MICHAEL LOMANO MD

Provider Business Mailing Address
First Line	:	15644 CALOOSA CREEK CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-6736
Country	:	US
Telephone Number	:	239-481-0929
Fax Number	:	239-481-7950

Provider Business Practice Location Address
First Line	:	15644 CALOOSA CREEK CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-6736
Country	:	US
Telephone Number	:	239-481-0929
Fax Number	:	239-481-7950

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

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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