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General NPI Number Information
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NPI Number | 1033166178
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Entity Type | Organization
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Legal Business Name | CRESTANI FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2745 BOB WALLACE AVE SW SUITE D
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City | HUNTSVILLE
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State | AL
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Zip | 35805-4158
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Country | US
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Telephone | 256-534-1323
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Fax | 256-534-1780
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Provider Business Mailing Address
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Address Line | PO BOX 2586
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City | HUNTSVILLE
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State | AL
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Zip | 35804-2586
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Country | US
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Telephone | 256-534-1323
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Fax | 256-534-1780
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Authorized Official
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Title or Position | ACCOUNTS MANAGER
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Name | PANDA JO PALMER
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Credential |
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Telephone | 256-534-1323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23539
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License Number State | AL
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