Provider Demographics
NPI:1497989800
Name:LAI, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:LAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N WICKHAM RD
Mailing Address - Street 2:STE 311
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8661
Mailing Address - Country:US
Mailing Address - Phone:330-729-1933
Mailing Address - Fax:330-729-1861
Practice Address - Street 1:240 N WICKHAM RD
Practice Address - Street 2:STE 311
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8661
Practice Address - Country:US
Practice Address - Phone:330-729-1933
Practice Address - Fax:330-729-1861
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192814204D00000X
OH351234562084N0400X, 2084N0600X
FLME1297642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105338Medicaid
OHH333510OtherMEDICARE PTAN