MEDICARE: DR. EDWIN I LUGO LUGO 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	174400000X	Specialist	9703	PR

General Provider Information

NPI Number	:	1972572519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN I LUGO LUGO M.D.

Provider Business Mailing Address
First Line	:	441 CALLE SAN LEANDRO
Second Line	:	SAGRADO CORAZON
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4216
Country	:	US
Telephone Number	:	787-782-8055
Fax Number	:	787-782-7780

Provider Business Practice Location Address
First Line	:	1 CARR 21
Second Line	:	LAS LOMAS
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00926-2609
Country	:	US
Telephone Number	:	787-782-8055
Fax Number	:	787-782-7780

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	01/10/2011

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