MEDICARE: CHERE ROSHALL LUCAS ANTHONY M.D.

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	207N00000X	Dermatology Physician	ME98172	FL

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

General Provider Information

NPI Number	:	1346456365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERE ROSHALL LUCAS ANTHONY M.D.

Provider Business Mailing Address
First Line	:	4479 COLLINS
Second Line	:	# 2201
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140
Country	:	US
Telephone Number	:	305-458-0802
Fax Number	:	786-768-2017

Provider Business Practice Location Address
First Line	:	4779 COLLINS AVE
Second Line	:	2201
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3251
Country	:	US
Telephone Number	:	305-774-3878
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	12/19/2009

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