MEDICARE: LOVELY PHYSICIAN CARE CORP

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	:	1316303639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVELY PHYSICIAN CARE CORP

Provider Business Mailing Address
First Line	:	3300 TAMIAMI TRL
Second Line	:	UNIT 102
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8054
Country	:	US
Telephone Number	:	941-889-9525
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 TAMIAMI TRL
Second Line	:	UNIT 102
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8054
Country	:	US
Telephone Number	:	941-889-9525
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PIERRE LEROUX
Credential	:	MD
Telephone Number	:	941-889-9525

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	09/06/2016

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Directions to “LOVELY PHYSICIAN CARE CORP ” Practice Location

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