MEDICARE: PREFERRED PRIMARY CARE PHYSICIANS

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1750433074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED PRIMARY CARE PHYSICIANS

Provider Business Mailing Address
First Line	:	1910 COCHRAN RD
Second Line	:	SUITE 490
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-1203
Country	:	US
Telephone Number	:	412-531-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1168 WASHINGTON PIKE
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-2828
Country	:	US
Telephone Number	:	412-257-0260
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL LUTZ
Credential	:
Telephone Number	:	412-531-2902

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	02/25/2008

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