MEDICARE: MARIO E PROFET MD, RDMS, RDCS, RPVI

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	208D00000X	General Practice Physician	ACN304	FL
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular	76083
3	2471S1302X	Sonography Radiologic Technologist	76083
4	2471V0105X	Vascular Sonography Radiologic Technologist	76083
5	208D00000X	General Practice Physician	ME135981	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487795092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO E PROFET MD, RDMS, RDCS, RPVI

Provider Business Mailing Address
First Line	:	11017 N DALE MABRY HWY STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-3873
Country	:	US
Telephone Number	:	133-377-4028
Fax Number	:	813-461-6462

Provider Business Practice Location Address
First Line	:	11017 N DALE MABRY HWY STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-3873
Country	:	US
Telephone Number	:	813-337-7402
Fax Number	:	813-461-6462

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	10/24/2019

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Directions to “ MARIO E PROFET MD, RDMS, RDCS, RPVI” Practice Location

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