MEDICARE: DR. MARK EDWARD LAMIELLE DO

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	207Q00000X	Family Medicine Physician	34-00-4531	OH
2	207Q00000X	Family Medicine Physician	OS12113	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609877752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EDWARD LAMIELLE DO

Provider Business Mailing Address
First Line	:	10051 5TH STREET NORTH
Second Line	:	SUITE 200
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33702-2211
Country	:	US
Telephone Number	:	727-828-2370
Fax Number	:	727-568-6011

Provider Business Practice Location Address
First Line	:	787 CORTARO DR
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-6812
Country	:	US
Telephone Number	:	813-634-2500
Fax Number	:	813-634-3008

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	06/08/2021

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