MEDICARE: ANSELM O LAM M.D.

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	207Q00000X	Family Medicine Physician	19516	WI
2	207Q00000X	Family Medicine Physician	31127	CA

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

General Provider Information

NPI Number	:	1841386141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANSELM O LAM M.D.

Provider Business Mailing Address
First Line	:	1520 STOCKTON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-3354
Country	:	US
Telephone Number	:	415-391-9686
Fax Number	:	414-355-8644

Provider Business Practice Location Address
First Line	:	1520 STOCKTON ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-3354
Country	:	US
Telephone Number	:	415-391-9686
Fax Number	:	414-355-8644

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	02/28/2017

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Directions to “ ANSELM O LAM M.D.” Practice Location

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