MEDICARE: DR. ANNE MARIE MATESE D.O

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	OS 06735	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80926	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174524011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE MARIE MATESE D.O

Provider Business Mailing Address
First Line	:	3365 BURNS RD STE 100
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4302
Country	:	US
Telephone Number	:	561-626-4000
Fax Number	:	561-493-8172

Provider Business Practice Location Address
First Line	:	2676 SW IMMANUEL DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2738
Country	:	US
Telephone Number	:	772-219-4444
Fax Number	:	561-493-8172

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/06/2007

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