MEDICARE: A. B. CHAMP CORP

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1548541444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. B. CHAMP CORP

Provider Business Mailing Address
First Line	:	9999 NE 2ND AVE STE 202
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2345
Country	:	US
Telephone Number	:	305-751-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	9999 NE 2ND AVE STE 202
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2345
Country	:	US
Telephone Number	:	305-751-0011
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LYONEL CHAMPAGNE
Credential	:	OTR/L
Telephone Number	:	954-557-5651

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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Directions to “A. B. CHAMP CORP ” Practice Location

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