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NPI Code Detail

MEDICARE: FUSION VASCULAR, LLC

MEDICARE: FUSION VASCULAR, LLC
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
1207RI0011XInterventional Cardiology Physician

General Provider Information

NPI Number : 1497224174
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUSION VASCULAR, LLC
Provider Business Mailing Address
First Line : 3001 PALM HARBOR BLVD STE A
Second Line :
City : PALM HARBOR
State : FL
Zip : 34683-1930
Country : US
Telephone Number : 727-474-0090
Fax Number : 727-474-0055
Provider Business Practice Location Address
First Line : 800 PEARMAN AVE
Second Line :
City : CLEVELAND
State : MS
Zip : 38732-3502
Country : US
Telephone Number : 888-757-0838
Fax Number : 888-796-1835
Authorized Official
Title or Position : PRESIDENT
Name : FOLUSO FAKOREDE
Credential : MD
Telephone Number : 888-757-0838
Provider Enumeration Date : 11/25/2018
Last Update Date : 11/25/2018

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Directions to “FUSION VASCULAR, LLC ” Practice Location

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