MEDICARE: MR. MICHAEL P FANGMAN 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	207RH0003X	Hematology & Oncology Physician	G27775	CA

General Provider Information

NPI Number	:	1093711806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL P FANGMAN M.D.

Provider Business Mailing Address
First Line	:	P.O BOX 62106
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93160-2106
Country	:	US
Telephone Number	:	805-681-1761
Fax Number	:	805-681-1768

Provider Business Practice Location Address
First Line	:	2040 VIBORG RD
Second Line	:	SUITE 140
City	:	SOLVANG
State	:	CA
Zip	:	93463-2272
Country	:	US
Telephone Number	:	805-681-1761
Fax Number	:	805-681-1768

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	11/01/2011

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