MEDICARE: VENETIAN ISLE MEDICAL OB GYN CONSULTANT INC

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	174400000X	Specialist	ME34571	FL

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	:	1669500328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VENETIAN ISLE MEDICAL OB GYN CONSULTANT INC

Provider Business Mailing Address
First Line	:	3001 WEST HALLANDALE BEACH BLVD
Second Line	:	SUITE 200
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5158
Country	:	US
Telephone Number	:	954-456-4888
Fax Number	:	954-456-9721

Provider Business Practice Location Address
First Line	:	3001 W HALLANDALE BEACH BLVD
Second Line	:	SUITE 200
City	:	HALLANDALE
State	:	FL
Zip	:	33009-5155
Country	:	US
Telephone Number	:	954-456-4888
Fax Number	:	954-456-9721

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE P. DIGIACOMO
Credential	:	M.D.
Telephone Number	:	954-456-4888

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	06/02/2008

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Directions to “VENETIAN ISLE MEDICAL OB GYN CONSULTANT INC ” Practice Location

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