MEDICARE: FLORIDA LUNG

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	207RP1001X	Pulmonary Disease Physician	ME90923	FL

General Provider Information

NPI Number	:	1720003403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA LUNG

Provider Business Mailing Address
First Line	:	1530 LEE BLVD STE 1500
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4897
Country	:	US
Telephone Number	:	239-368-6646
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 LEE BLVD STE 1500
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-4897
Country	:	US
Telephone Number	:	239-368-6646
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISHNA PRIYA RAJU
Credential	:	MD
Telephone Number	:	239-368-6646

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	11/28/2007

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Directions to “FLORIDA LUNG ” Practice Location

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