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Organization
FANA MEDICAL GROUP, TAMPA RD LLC
Active
Organization
FANA MEDICAL GROUP, TAMPA RD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIGUEL ANTONIO FANA JR. MD (MEDICAL DIRECTOR / OWNER)
(727) 781-5811
Entity
Organization
Contact information
Practice address
2626 TAMPA ROAD, SUITE 202, PALM HARBOR, FL 34684
(727) 781-5811
(727) 781-5613
Mailing address
2626 TAMPA ROAD, SUITE #202, PALM HARBOR, FL 34684
(727) 781-5811
(727) 781-5613
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME80639
FL
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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