MEDICARE: JOAN ELIZABETH ST ONGE 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	ME97027	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1477553212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN ELIZABETH ST ONGE M.D.

Provider Business Mailing Address
First Line	:	1600 NW 10TH AVENUE
Second Line	:	ROOM 1149 (LOCATOR CODE C-203)
City	:	MIAMI
State	:	FL
Zip	:	33136
Country	:	US
Telephone Number	:	305-243-9638
Fax Number	:	305-243-1853

Provider Business Practice Location Address
First Line	:	1600 NW 10TH AVENUE
Second Line	:	ROOM 1149 (LOCATOR CODE C-203)
City	:	MIAMI
State	:	FL
Zip	:	33136
Country	:	US
Telephone Number	:	305-243-9638
Fax Number	:	305-243-1853

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	10/14/2015

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