MEDICARE: MR. FABIO MARIANO MEHRGUT 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	208000000X	Pediatrics Physician	168071	NY
2	208000000X	Pediatrics Physician	ME122911	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174504690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FABIO MARIANO MEHRGUT M.D.

Provider Business Mailing Address
First Line	:	16255 SW 83RD LANE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193
Country	:	US
Telephone Number	:	786-479-7878
Fax Number	:	305-246-5880

Provider Business Practice Location Address
First Line	:	16255 SW 83RD LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-5133
Country	:	US
Telephone Number	:	786-479-7878
Fax Number	:	305-246-5880

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	08/18/2021

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