MEDICARE: CARLO PONTI 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	207L00000X	Anesthesiology Physician	5101018432	MI
2	207L00000X	Anesthesiology Physician	OS12336	FL
3	207L00000X	Anesthesiology Physician	DO1641	NV

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

General Provider Information

NPI Number	:	1780813865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLO PONTI D.O.

Provider Business Mailing Address
First Line	:	4823 NW 91ST WAY
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-1908
Country	:	US
Telephone Number	:	800-243-3839
Fax Number	:	954-839-2569

Provider Business Practice Location Address
First Line	:	4823 NW 91ST WAY
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-1908
Country	:	US
Telephone Number	:	954-702-9672
Fax Number	:	954-702-9672

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

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	05/16/2019

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Directions to “ CARLO PONTI D.O.” Practice Location

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