MEDICARE: ALEXANDRA MARIE LACQUA 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	ME160890	FL

General Provider Information

NPI Number	:	1598393852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA MARIE LACQUA MD

Provider Business Mailing Address
First Line	:	4601 N CONGRESS AVE STE 200
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3381
Country	:	US
Telephone Number	:	561-840-4710
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 N CONGRESS AVE STE 200
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3381
Country	:	US
Telephone Number	:	561-840-4660
Fax Number	:

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

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	12/04/2025

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