MEDICARE: DR. ALIX LANOUE 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	207RG0100X	Gastroenterology Physician	ME86925	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598766099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALIX LANOUE M.D.

Provider Business Mailing Address
First Line	:	4700 SHERIDAN ST
Second Line	:	SUITE M
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3420
Country	:	US
Telephone Number	:	954-961-8400
Fax Number	:	954-961-8401

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST
Second Line	:	SUITE 109
City	:	COOPER CITY
State	:	FL
Zip	:	33026-1505
Country	:	US
Telephone Number	:	954-961-8400
Fax Number	:	954-961-8401

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/24/2016

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