Individual
MR. RICKY K LO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8940 N KENDALL DR STE 601E, MIAMI, FL 33176-2150
(786) 596-8020
(786) 533-9358
Mailing address
PO BOX 100905, ATLANTA, GA 30384-0905
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9102314
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U1473
MEDICARE PTAN
FL
Enumeration date
05/10/2006
Last updated
08/10/2022
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