MEDICARE: MR. FRED CSABA ESTOK LP

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	224P00000X	Prosthetist	PRO1	FL

General Provider Information

NPI Number	:	1538373378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED CSABA ESTOK LP

Provider Business Mailing Address
First Line	:	22310 COUNTY ROAD 455
Second Line	:
City	:	HOWEY IN THE HILLS
State	:	FL
Zip	:	34737-4516
Country	:	US
Telephone Number	:	352-243-4032
Fax Number	:

Provider Business Practice Location Address
First Line	:	22310 COUNTY ROAD 455
Second Line	:
City	:	HOWEY IN THE HILLS
State	:	FL
Zip	:	34737-4516
Country	:	US
Telephone Number	:	352-243-4032
Fax Number	:

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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