Healthcare Provider Details

I. General information

NPI: 1710903588
Provider Name (Legal Business Name): FRED F TELISCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-1484
  • Fax:
Mailing address:
  • Phone: 305-243-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberME49637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: