MEDICARE: MR. ARQUIMEDES LOPES RPT

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	208100000X	Physical Medicine & Rehabilitation Physician	PT00010923	FL

General Provider Information

NPI Number	:	1629070339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARQUIMEDES LOPES RPT

Provider Business Mailing Address
First Line	:	200 MIAMI AVE
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3519
Country	:	US
Telephone Number	:	321-506-4830
Fax Number	:	321-220-0566

Provider Business Practice Location Address
First Line	:	200 MIAMI AVE
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3519
Country	:	US
Telephone Number	:	321-506-4830
Fax Number	:	321-220-0566

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/01/2011

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