MEDICARE: ANDREW LIE DVM

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	174M00000X	Veterinarian	16588	CA

General Provider Information

NPI Number	:	1346586302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LIE DVM

Provider Business Mailing Address
First Line	:	820 D ST
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2814
Country	:	US
Telephone Number	:	415-456-4463
Fax Number	:	415-456-3786

Provider Business Practice Location Address
First Line	:	820 D ST
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-2814
Country	:	US
Telephone Number	:	415-456-4463
Fax Number	:	415-456-3786

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

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	12/19/2012

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