MEDICARE: EDWARD CRAIG FACUNDUS 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	174400000X	Specialist	19052	AL

General Provider Information

NPI Number	:	1588622617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD CRAIG FACUNDUS MD

Provider Business Mailing Address
First Line	:	250 CHATEAU DR SW
Second Line	:	SUITE 105
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-6436
Country	:	US
Telephone Number	:	256-880-1977
Fax Number	:	256-880-6022

Provider Business Practice Location Address
First Line	:	250 CHATEAU DR SW
Second Line	:	SUITE 105
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-6436
Country	:	US
Telephone Number	:	256-880-1977
Fax Number	:	256-880-6022

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/09/2007

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