MEDICARE: PRAISE PEDIATRICS 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	208000000X	Pediatrics Physician	37592	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L13964732	OTHER	AZ	LLC REGISTRATION #

General Provider Information

NPI Number	:	1386833119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAISE PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	PO BOX 3502
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86405-3502
Country	:	US
Telephone Number	:	928-855-0520
Fax Number	:	928-855-0537

Provider Business Practice Location Address
First Line	:	84 ACOMA BLVD N
Second Line	:	SUITE 104
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6096
Country	:	US
Telephone Number	:	928-855-0520
Fax Number	:	928-855-0537

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MONETTE PIERRE-LOUIS
Credential	:	M.D.
Telephone Number	:	928-855-0520

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/17/2007

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Directions to “PRAISE PEDIATRICS LLC ” Practice Location

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