MEDICARE: DR. CATHERINE A. FEDAKO 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	207R00000X	Internal Medicine Physician	ME57605	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548254204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE A. FEDAKO MD

Provider Business Mailing Address
First Line	:	2446 LAUREL RD E
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-3204
Country	:	US
Telephone Number	:	941-218-6200
Fax Number	:	941-218-6182

Provider Business Practice Location Address
First Line	:	2446 LAUREL RD E
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-3204
Country	:	US
Telephone Number	:	941-218-6200
Fax Number	:	941-218-6182

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	03/21/2020

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