MEDICARE: VERONIQUE POULIN 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	282N00000X	General Acute Care Hospital	80969	AZ

General Provider Information

NPI Number	:	1528262771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONIQUE POULIN M.D

Provider Business Mailing Address
First Line	:	2901 E FORT LOWELL RD
Second Line	:	#227
City	:	TUCSON
State	:	AZ
Zip	:	85716-1531
Country	:	US
Telephone Number	:	520-319-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N. CAMPBELL AVENUE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716
Country	:	US
Telephone Number	:	520-626-2761
Fax Number	:

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/25/2007

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