MEDICARE: STEFANI FONTANA 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	2086S0122X	Plastic and Reconstructive Surgery Physician	U1272	TX
2	208200000X	Plastic Surgery Physician	U1272	TX

General Provider Information

NPI Number	:	1619408325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANI FONTANA M.D.

Provider Business Mailing Address
First Line	:	1323 W 23RD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1609
Country	:	US
Telephone Number	:	913-333-8763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 W 23RD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1609
Country	:	US
Telephone Number	:	913-333-8763
Fax Number	:

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

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	10/21/2025

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