MEDICARE: AMY LAI 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	207Y00000X	Otolaryngology Physician	01055046A	IN

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

General Provider Information

NPI Number	:	1679565501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LAI MD

Provider Business Mailing Address
First Line	:	10021 DUPONT CIRCLE CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1604
Country	:	US
Telephone Number	:	260-426-8117
Fax Number	:	260-420-0817

Provider Business Practice Location Address
First Line	:	1169 N MAIN ST
Second Line	:	SUITE 5
City	:	BLUFFTON
State	:	IN
Zip	:	46714-1360
Country	:	US
Telephone Number	:	260-827-4368
Fax Number	:	260-827-4370

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	06/20/2016

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Directions to “ AMY LAI MD” Practice Location

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