MEDICARE: DR. ANTONIO E TERRELONGE MD

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	207Q00000X	Family Medicine Physician	ME92001	FL

General Provider Information

NPI Number	:	1386757102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO E TERRELONGE MD

Provider Business Mailing Address
First Line	:	1901 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3410
Country	:	US
Telephone Number	:	305-587-2414
Fax Number	:	305-938-8054

Provider Business Practice Location Address
First Line	:	1901 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3410
Country	:	US
Telephone Number	:	305-587-2414
Fax Number	:	305-938-8054

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/05/2016

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