MEDICARE: BYLSMA LEA ALLEN 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	207L00000X	Anesthesiology Physician	ME44211	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	10174	OTHER		BCBS

General Provider Information

NPI Number	:	1861430100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYLSMA LEA ALLEN MD

Provider Business Mailing Address
First Line	:	1874 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5545
Country	:	US
Telephone Number	:	772-337-7676
Fax Number	:	772-337-9034

Provider Business Practice Location Address
First Line	:	1874 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5545
Country	:	US
Telephone Number	:	772-337-7676
Fax Number	:	772-337-9034

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	06/07/2011

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Directions to “ BYLSMA LEA ALLEN MD” Practice Location

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