MEDICARE: DR. FLORA ERMENIA BIANCALANA 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	207Q00000X	Family Medicine Physician	4301072242	MI

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	:	1649238098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLORA ERMENIA BIANCALANA MD

Provider Business Mailing Address
First Line	:	3189 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	231-932-1988
Fax Number	:	231-932-7693

Provider Business Practice Location Address
First Line	:	3189 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	231-932-1988
Fax Number	:	231-932-7693

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	06/27/2008

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