MEDICARE: DESIREE GRANADOS-FISCHEL 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	207V00000X	Obstetrics & Gynecology Physician	ME89969	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	FQ173Z	OTHER	FL	MEDICARE
6	P01000600	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2130785	OTHER	FL	CIGNA
2	7205609	OTHER	FL	AETNA
3	14HL9	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548271869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE GRANADOS-FISCHEL MD

Provider Business Mailing Address
First Line	:	19348 LA SERENA DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-0525
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19348 LA SERENA DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-0525
Country	:	US
Telephone Number	:	239-691-4535
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	10/05/2012

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