MEDICARE: NANCY TE LAO 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	207Q00000X	Family Medicine Physician	8774	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
2	8774	OTHER	NV	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174596431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY TE LAO MD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	725-258-2982
Fax Number	:	877-709-4341

Provider Business Practice Location Address
First Line	:	4517 BLUE DIAMOND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7620
Country	:	US
Telephone Number	:	725-258-2982
Fax Number	:	877-709-4341

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/25/2025

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