# FANA MEDICAL GROUP PORT RICHEY LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1356689111
- **Authorized official:** DR. MIGUEL A FANA JR. M.D. (PRESIDENT)
- **Authorized official phone:** (813) 382-7898

## Contact information

- **Practice address:** 7505 ROTTINGHAM RD, PORT RICHEY, FL 34668-2648
- **Practice address phone:** (727) 849-2600
- **Practice address fax:** (727) 847-7703
- **Mailing address:** 5537 GULF DR, NEW PORT RICHEY, FL 34652-4021
- **Mailing address phone:** (727) 849-2600
- **Mailing address fax:** (727) 847-7703

## Taxonomy

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

## Other

- **Enumeration date:** 01/29/2013
- **Last updated:** 01/29/2013