MEDICARE: FABIAN FONTAINE FIGUEREDO MD CORP

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

General Provider Information

NPI Number	:	1407147598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FABIAN FONTAINE FIGUEREDO MD CORP

Provider Business Mailing Address
First Line	:	6703 SW 105TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1365
Country	:	US
Telephone Number	:	305-335-0607
Fax Number	:	305-663-5882

Provider Business Practice Location Address
First Line	:	6703 SW 105TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1365
Country	:	US
Telephone Number	:	305-335-0607
Fax Number	:	305-663-5882

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FABIAN FONTAINE FIGUEREDO
Credential	:	MD
Telephone Number	:	305-335-0607

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	04/25/2011

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