MEDICARE: FANA MEDICAL GROUP NEW PORT RICHEY

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	ME80639	FL

General Provider Information

NPI Number	:	1386982304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FANA MEDICAL GROUP NEW PORT RICHEY

Provider Business Mailing Address
First Line	:	5537 GULF DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4021
Country	:	US
Telephone Number	:	727-849-2600
Fax Number	:	727-847-7703

Provider Business Practice Location Address
First Line	:	5537 GULF DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4021
Country	:	US
Telephone Number	:	727-849-2600
Fax Number	:	727-847-7703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIGUEL A FANA JR.
Credential	:	M.D.
Telephone Number	:	813-382-7898

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/30/2013

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