MEDICARE: DR. VIRGINIA FEGERT 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	207L00000X	Anesthesiology Physician	ME53880	FL

General Provider Information

NPI Number	:	1922028414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA FEGERT MD

Provider Business Mailing Address
First Line	:	255 W MICHIGAN AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-2218
Country	:	US
Telephone Number	:	517-787-6440
Fax Number	:	517-787-4146

Provider Business Practice Location Address
First Line	:	1555 INDIAN RIVER BLVD
Second Line	:	B-120
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7103
Country	:	US
Telephone Number	:	772-778-9621
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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