MEDICARE: DR. MORNINGSTAR ANTON D.O.

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	OS9388	FL

General Provider Information

NPI Number	:	1598871527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORNINGSTAR ANTON D.O.

Provider Business Mailing Address
First Line	:	632 15TH ST APT 203
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3546
Country	:	US
Telephone Number	:	561-856-6608
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 15TH ST APT 203
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3546
Country	:	US
Telephone Number	:	561-856-6608
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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