MEDICARE: DR. ISEL GERTRUDIS LEMUS D.M.D.

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	1223G0001X	General Practice Dentistry	DN 20326	FL

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	:	1033541537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISEL GERTRUDIS LEMUS D.M.D.

Provider Business Mailing Address
First Line	:	17800 ATLANTIC BLVD APT 309
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-2705
Country	:	US
Telephone Number	:	813-802-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1462 W 84TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3363
Country	:	US
Telephone Number	:	305-557-7903
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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