# FANA MEDICAL GROUP, TAMPA RD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265785869
- **Authorized official:** DR. MIGUEL ANTONIO FANA JR. MD (MEDICAL DIRECTOR / OWNER)
- **Authorized official phone:** (727) 781-5811

## Contact information

- **Practice address:** 2626 TAMPA ROAD, SUITE 202, PALM HARBOR, FL 34684
- **Practice address phone:** (727) 781-5811
- **Practice address fax:** (727) 781-5613
- **Mailing address:** 2626 TAMPA ROAD, SUITE \#202, PALM HARBOR, FL 34684
- **Mailing address phone:** (727) 781-5811
- **Mailing address fax:** (727) 781-5613

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | ME80639 | FL | Yes |

## Other

- **Enumeration date:** 10/19/2012
- **Last updated:** 10/19/2012