MEDICARE: DR. LUIS BIRD 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	2084P0800X	Psychiatry Physician	MD021400E	PA

General Provider Information

NPI Number	:	1538222658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS BIRD M.D.

Provider Business Mailing Address
First Line	:	2012 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-3849
Country	:	US
Telephone Number	:	215-426-4784
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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