MEDICARE: DR. VINCENT LOUIS TRAVISANO DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	000459	MO

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	:	1932189115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT LOUIS TRAVISANO DPM

Provider Business Mailing Address
First Line	:	7509 BIG BEND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2103
Country	:	US
Telephone Number	:	314-961-3113
Fax Number	:	314-968-7529

Provider Business Practice Location Address
First Line	:	7509 BIG BEND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2103
Country	:	US
Telephone Number	:	314-961-3113
Fax Number	:	314-968-7529

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

Provider Enumeration Date	:	01/22/2006
Last Update Date	:	06/13/2013

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