MEDICARE: MS. MAILE FISCUS MCKAIN L.AC., DIPL. O.M.

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	5194233-1201	UT

General Provider Information

NPI Number	:	1720231889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAILE FISCUS MCKAIN L.AC., DIPL. O.M.

Provider Business Mailing Address
First Line	:	900 BITNER RD
Second Line	:	L-33
City	:	PARK CITY
State	:	UT
Zip	:	84098-5404
Country	:	US
Telephone Number	:	435-602-9750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 SIDEWINDER DR
Second Line	:	SUITE 206
City	:	PARK CITY
State	:	UT
Zip	:	84060-7329
Country	:	US
Telephone Number	:	435-602-9750
Fax Number	:

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

Provider Enumeration Date	:	11/02/2008
Last Update Date	:	11/02/2008

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