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NPI Code Detail

MEDICARE: MIRTA M. MEDEROS-LEZCANO MD

MEDICARE: MIRTA M. MEDEROS-LEZCANO 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
1207L00000XAnesthesiology PhysicianME64316FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164495289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRTA M. MEDEROS-LEZCANO MD
Provider Business Mailing Address
First Line : PO BOX 817737
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33081-1737
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7700 W SUNRISE BLVD # 200
Second Line :
City : PLANTATION
State : FL
Zip : 33322-4113
Country : US
Telephone Number : 954-838-2371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 03/26/2021

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