MEDICARE: ADVANCED THERAPEUTICS LASER 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1265522122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED THERAPEUTICS LASER LLC

Provider Business Mailing Address
First Line	:	209 NE 95TH ST
Second Line	:	SUITE 2
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2745
Country	:	US
Telephone Number	:	305-757-0523
Fax Number	:	305-757-0524

Provider Business Practice Location Address
First Line	:	209 NE 95TH ST
Second Line	:	SUITE 2
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2745
Country	:	US
Telephone Number	:	305-757-0523
Fax Number	:	305-757-0524

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANK C PIERRE
Credential	:	M.D.
Telephone Number	:	305-757-0523

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/22/2020

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