MEDICARE: IVO D PESTANA 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	2086S0122X	Plastic and Reconstructive Surgery Physician	ME33915	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GI432Z	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942258645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVO D PESTANA MD

Provider Business Mailing Address
First Line	:	3100 CORAL HILLS DR
Second Line	:	NO 201
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4137
Country	:	US
Telephone Number	:	954-755-8844
Fax Number	:	954-755-0272

Provider Business Practice Location Address
First Line	:	3100 CORAL HILLS DR
Second Line	:	NO 201
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4137
Country	:	US
Telephone Number	:	954-755-8844
Fax Number	:	954-755-0272

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/16/2023

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Directions to “ IVO D PESTANA MD” Practice Location

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