MEDICARE: DR. GERARDO FELICIANO-VASQUEZ 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	207R00000X	Internal Medicine Physician	4301071373	MI
2	207R00000X	Internal Medicine Physician	ME105191	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0N985000011	OTHER	MI	MEDICARE ADVANTAGE
3	DE030Y OFFICE PRACT	OTHER	FL	MEDICARE PTAN
6	DE030Y	OTHER	FL	MEDICARE PTAN PLAZA DE LA SALUD OFFICE
8	DE030Z	OTHER	FL	MEDICARE PTAN

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
4	025020	OTHER	MI	MIDWEST HEALTH PLAN
5	148P1	OTHER	FL	BC/BS
7	110H229590	OTHER	MI	BCBS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	201340828	OTHER	MI	GREAT WEST HEALTH CARE
11	8042	OTHER	MI	TOTAL HEALTH CARE

General Provider Information

NPI Number	:	1942283429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARDO FELICIANO-VASQUEZ MD

Provider Business Mailing Address
First Line	:	3502 MOLONA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-5828
Country	:	US
Telephone Number	:	407-300-2936
Fax Number	:

Provider Business Practice Location Address
First Line	:	3502 MOLONA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-5828
Country	:	US
Telephone Number	:	407-300-2936
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	10/12/2012

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