Healthcare Provider Details

I. General information

NPI: 1447499702
Provider Name (Legal Business Name): MICHAEL JY LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 N COMMERCE PKWY SUITE 2
WESTON FL
33326-3250
US

IV. Provider business mailing address

2237 N COMMERCE PKWY SUITE 2
WESTON FL
33326-3250
US

V. Phone/Fax

Practice location:
  • Phone: 954-888-6650
  • Fax:
Mailing address:
  • Phone: 954-888-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: