MEDICARE: DR. ANGELO MIGUEL FERNANDES 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	207RG0100X	Gastroenterology Physician	ME91189	FL
2	207RG0100X	Gastroenterology Physician	MD30147	ME

General Provider Information

NPI Number	:	1316980071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELO MIGUEL FERNANDES MD

Provider Business Mailing Address
First Line	:	3000 MEDICAL PARK DR STE 500
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-6600
Country	:	US
Telephone Number	:	813-615-7028
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 MEDICAL PARK DR STE 500
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-6600
Country	:	US
Telephone Number	:	813-615-7028
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/02/2026

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