Provider Demographics
NPI:1205181575
Name:LAM A, AU, M.D., PH.D., P.A.
Entity Type:Organization
Organization Name:LAM A, AU, M.D., PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-255-2505
Mailing Address - Street 1:9275 SW 152ND ST
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1701
Mailing Address - Country:US
Mailing Address - Phone:305-255-2505
Mailing Address - Fax:
Practice Address - Street 1:9275 SW 152ND ST
Practice Address - Street 2:SUITE 108A
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1701
Practice Address - Country:US
Practice Address - Phone:305-255-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
34023OtherFLORIDA BLUE
FL049-4917-00Medicaid
FL34023Medicare PIN
34023OtherFLORIDA BLUE