MEDICARE: LILL E. CHAMORRO 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
1	2084P0800X	Psychiatry Physician	ME128984	FL

General Provider Information

NPI Number	:	1164703088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILL E. CHAMORRO MD

Provider Business Mailing Address
First Line	:	307 SE YARDLEY TER
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-2140
Country	:	US
Telephone Number	:	315-506-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 NW PEACOCK BLVD STE 10
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-2213
Country	:	US
Telephone Number	:	954-497-3856
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	06/14/2024

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