Individual
MICHAEL E FANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 TAMPA GENERAL CIR, MDC 15, TAMPA, FL 33606-3603
(727) 553-3544
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
H1486
TX
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME103878
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129265805
—
TX
01
—
129265806
CSHCN
TX
01
—
29873
BLUE CROSS BLUE SHIELD
FL
01
—
85717F
BCBS
TX
Enumeration date
06/23/2006
Last updated
05/14/2009
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