MEDICARE: HEALTHEAST MEDICAL GROUP, INC.

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 1262	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C005L	OTHER	FL	BCBS #

General Provider Information

NPI Number	:	1073726378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHEAST MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	6300 NW 5TH WAY
Second Line	:	SUITE 150
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-6110
Country	:	US
Telephone Number	:	954-771-1007
Fax Number	:	954-771-9930

Provider Business Practice Location Address
First Line	:	6300 NW 5TH WAY
Second Line	:	SUITE 150
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-6110
Country	:	US
Telephone Number	:	954-771-1007
Fax Number	:	954-771-9930

Authorized Official
Title or Position	:	ACUPUNCTURE PHYSICIAN
Name	:	DR. IRIS CHEN
Credential	:	A.P.
Telephone Number	:	954-771-1007

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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Directions to “HEALTHEAST MEDICAL GROUP, INC. ” Practice Location

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