MEDICARE: DR. MACIEJ FERENC DO

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	207P00000X	Emergency Medicine Physician	OS8400	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17459	OTHER	FL	MEDICARE CORE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467458596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MACIEJ FERENC DO

Provider Business Mailing Address
First Line	:	3114 CROASDAILE DR
Second Line	:	SUITE 200
City	:	DURHAM
State	:	NC
Zip	:	27705-2508
Country	:	US
Telephone Number	:	919-425-1565
Fax Number	:	919-425-0478

Provider Business Practice Location Address
First Line	:	1600 S ANDREWS AVE
Second Line	:	EMERGENCY DEPARTMENT
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2510
Country	:	US
Telephone Number	:	919-425-1565
Fax Number	:	919-425-0478

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	11/05/2009

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Directions to “ DR. MACIEJ FERENC DO” Practice Location

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