MEDICARE: WYSLAINE LAMONTAGNE 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	207R00000X	Internal Medicine Physician	253505	NY
2	207R00000X	Internal Medicine Physician	ME104209	FL

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	:	1811182918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYSLAINE LAMONTAGNE MD

Provider Business Mailing Address
First Line	:	4212 NORTHLAKE BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6252
Country	:	US
Telephone Number	:	561-841-6252
Fax Number	:	561-841-6260

Provider Business Practice Location Address
First Line	:	4212 NORTHLAKE BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6252
Country	:	US
Telephone Number	:	561-841-6252
Fax Number	:	561-841-6260

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	01/06/2014

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