MEDICARE: JOHN R. LEMIEUX MD LTD

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	3602	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023345071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN R. LEMIEUX MD LTD

Provider Business Mailing Address
First Line	:	6630 S. MCCORRAN BLVD.
Second Line	:	BUILDING B SUITE 16
City	:	RENO
State	:	NV
Zip	:	89509-6145
Country	:	US
Telephone Number	:	775-323-5116
Fax Number	:	775-323-7140

Provider Business Practice Location Address
First Line	:	6630 S. MCCORRAN BLVD
Second Line	:	BUILDING B SUITE 16
City	:	RENO
State	:	NV
Zip	:	89509-6145
Country	:	US
Telephone Number	:	775-323-5116
Fax Number	:	775-323-7140

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	VICKI A. LEMIEUX
Credential	:
Telephone Number	:	775-323-5116

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	10/25/2011

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