MEDICARE: ELIZABETH LE,DPM,LLC

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	335E00000X	Prosthetic/Orthotic Supplier	PD173R	LA
2	332B00000X	Durable Medical Equipment & Medical Supplies	PD173R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1246390002	OTHER	LA	PTAN

General Provider Information

NPI Number	:	1225422264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH LE,DPM,LLC

Provider Business Mailing Address
First Line	:	1524 S RANGE AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5218
Country	:	US
Telephone Number	:	225-667-6497
Fax Number	:	225-791-3899

Provider Business Practice Location Address
First Line	:	1524 S RANGE AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5218
Country	:	US
Telephone Number	:	225-667-6497
Fax Number	:	225-791-3899

Authorized Official
Title or Position	:	PODIATRIST/OWNER
Name	:	ELIZABETH LE
Credential	:	DPM
Telephone Number	:	225-667-6497

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	03/27/2015

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