Healthcare Provider Details

I. General information

NPI: 1124010111
Provider Name (Legal Business Name): MICHAEL JOHN FESTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 NORTH ST
SACO ME
04072-1903
US

IV. Provider business mailing address

42 NORTH ST
SACO ME
04072-1903
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-1559
  • Fax:
Mailing address:
  • Phone: 207-282-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number006038
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: