MEDICARE: B. MICHAEL MAX L.AC

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	171100000X	Acupuncturist	481	WA

General Provider Information

NPI Number	:	1972797264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	B. MICHAEL MAX L.AC

Provider Business Mailing Address
First Line	:	1515 FIRST AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101
Country	:	US
Telephone Number	:	206-903-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 FIRST AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101
Country	:	US
Telephone Number	:	206-903-1888
Fax Number	:

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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