MEDICARE: DR. JOSEPH JAMES FASTAIA 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	ME39166	FL

General Provider Information

NPI Number	:	1508937103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH JAMES FASTAIA M.D.

Provider Business Mailing Address
First Line	:	4891 KYLEMORE CT
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2649
Country	:	US
Telephone Number	:	727-942-6834
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 71ST ST
Second Line	:	SUITE# 620
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3038
Country	:	US
Telephone Number	:	305-866-9951
Fax Number	:	305-614-3352

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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