MEDICARE: MAI T LE MD

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	207R00000X	Internal Medicine Physician	A98060	CA
2	208M00000X	Hospitalist Physician	A98060	CA

General Provider Information

NPI Number	:	1497878607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI T LE MD

Provider Business Mailing Address
First Line	:	1800 HARRISON ST FL 7
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-3466
Country	:	US
Telephone Number	:	510-625-4101
Fax Number	:	877-738-4262

Provider Business Practice Location Address
First Line	:	3132 W MARCH LN STE 5
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-2354
Country	:	US
Telephone Number	:	209-475-5500
Fax Number	:	209-475-5515

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	12/21/2021

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Directions to “ MAI T LE MD” Practice Location

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