MEDICARE: JOAO R MACEDO, FILHO MD

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	2085R0202X	Diagnostic Radiology Physician	2207951	NY
2	2085R0202X	Diagnostic Radiology Physician	4301070995	MI

General Provider Information

NPI Number	:	1134235195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAO R MACEDO, FILHO MD

Provider Business Mailing Address
First Line	:	225 SE 28TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-5436
Country	:	US
Telephone Number	:	954-933-1376
Fax Number	:	954-933-1376

Provider Business Practice Location Address
First Line	:	225 SE 28TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-5436
Country	:	US
Telephone Number	:	954-933-1376
Fax Number	:	954-933-1376

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	06/26/2008

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