MEDICARE: DR. KELLY A FONTANA MD

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	ME98117	FL
2	208000000X	Pediatrics Physician	ME98117	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	AD185Y	OTHER	FL	MEDICARE PTAN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518965292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY A FONTANA MD

Provider Business Mailing Address
First Line	:	1585 PINE RIDGE RD
Second Line	:	SUITE 2
City	:	NAPLES
State	:	FL
Zip	:	34109-2105
Country	:	US
Telephone Number	:	239-451-3143
Fax Number	:	239-451-3145

Provider Business Practice Location Address
First Line	:	1585 PINE RIDGE RD
Second Line	:	SUITE 2
City	:	NAPLES
State	:	FL
Zip	:	34109-2105
Country	:	US
Telephone Number	:	239-451-3143
Fax Number	:	239-451-3145

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/25/2016

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Directions to “ DR. KELLY A FONTANA MD” Practice Location

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