MEDICARE: FOUR GATES ORIENTAL MEDICINE INC

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	171100000X	Acupuncturist	AP 1706	FL

General Provider Information

NPI Number	:	1619038338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR GATES ORIENTAL MEDICINE INC

Provider Business Mailing Address
First Line	:	5311 SW 90TH AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-5112
Country	:	US
Telephone Number	:	954-326-7310
Fax Number	:	954-680-6728

Provider Business Practice Location Address
First Line	:	1189 SW 26TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-3017
Country	:	US
Telephone Number	:	954-326-7310
Fax Number	:	954-797-0331

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLAIRE E FITCH
Credential	:	ACUP PHYSICIAN
Telephone Number	:	954-326-7310

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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