MEDICARE: DR. ANDRES AMILCAR BONELLI M.D.

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	207Q00000X	Family Medicine Physician	ME95071	FL

General Provider Information

NPI Number	:	1063601961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRES AMILCAR BONELLI M.D.

Provider Business Mailing Address
First Line	:	36454 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1330
Country	:	US
Telephone Number	:	727-460-7049
Fax Number	:	727-787-6221

Provider Business Practice Location Address
First Line	:	36454 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1330
Country	:	US
Telephone Number	:	727-460-7049
Fax Number	:	727-787-6221

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

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	12/15/2008

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