MEDICARE: DR. CARLOS ANTONIO FUMERO 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	207R00000X	Internal Medicine Physician	ME 94508	FL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME94508	FL

General Provider Information

NPI Number	:	1184710501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ANTONIO FUMERO M.D.

Provider Business Mailing Address
First Line	:	5301 N HABANA AVE
Second Line	:	STE 1
City	:	TAMPA
State	:	FL
Zip	:	33614-6890
Country	:	US
Telephone Number	:	813-876-3636
Fax Number	:	813-870-0077

Provider Business Practice Location Address
First Line	:	205 N PLANT AVE
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4731
Country	:	US
Telephone Number	:	813-876-3636
Fax Number	:	813-870-0077

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/12/2016

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