Organization
LUNG CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT A FASOLI M.D. (OWNER/PRES)
(941) 792-0611
Entity
Organization
Contact information
Practice address
2210 61ST ST W, BRADENTON, FL 34209-5527
(941) 792-0611
(941) 792-0086
Mailing address
2210 61ST ST W, BRADENTON, FL 34209-5527
(941) 792-0611
(941) 792-0086
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207RP1001X
TAXONOMY
FL
Enumeration date
09/22/2006
Last updated
11/20/2009
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