MEDICARE: DR. MICHAEL JOHN FESTINO 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	207RC0000X	Cardiovascular Disease Physician	006038	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002159	OTHER	ME	ANTHEM STAR ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124010111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN FESTINO M.D.

Provider Business Mailing Address
First Line	:	42 NORTH ST
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-1903
Country	:	US
Telephone Number	:	207-282-1559
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 NORTH ST
Second Line	:
City	:	SACO
State	:	ME
Zip	:	04072-1903
Country	:	US
Telephone Number	:	207-282-1559
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	09/22/2010

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Directions to “ DR. MICHAEL JOHN FESTINO M.D.” Practice Location

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