Healthcare Provider Details

I. General information

NPI: 1447451158
Provider Name (Legal Business Name): STEVEN FAGIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GLADES RD SUITE 210
BOCA RATON FL
33431-6465
US

IV. Provider business mailing address

660 GLADES RD SUITE 210
BOCA RATON FL
33431-6465
US

V. Phone/Fax

Practice location:
  • Phone: 561-393-9898
  • Fax: 561-347-0772
Mailing address:
  • Phone: 561-393-9898
  • Fax: 561-347-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME0044451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: