Provider Demographics
NPI:1124023890
Name:LAI, MING TAO (MD)
Entity Type:Individual
Prefix:DR
First Name:MING
Middle Name:TAO
Last Name:LAI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:910 MALABAR RD SE
Mailing Address - Street 2:STE 2
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3200
Mailing Address - Country:US
Mailing Address - Phone:321-768-2356
Mailing Address - Fax:321-726-6388
Practice Address - Street 1:910 MALABAR RD SE
Practice Address - Street 2:STE 2
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3200
Practice Address - Country:US
Practice Address - Phone:321-768-2356
Practice Address - Fax:321-726-6388
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-07-11
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Provider Licenses
StateLicense IDTaxonomies
FL0063146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00129507OtherRAILROAD MEDICARE
FLF47858Medicare UPIN
FLP00129507OtherRAILROAD MEDICARE