Provider Demographics
NPI:1063448173
Name:POTENTI, FABIO M (MD)
Entity Type:Individual
Prefix:
First Name:FABIO
Middle Name:M
Last Name:POTENTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 CLEVELAND CLINIC BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:934-689-5784
Mailing Address - Fax:
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:954-689-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75795208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271217200Medicaid
FL50587OtherNHP
FL0182289OtherGROUP HEALTH INC
FL179405OtherJACKSON MEMORIAL HEALTH
FL294851OtherAVMED HEALTH PLANS
FL901933OtherCIGNA
FL1048169OtherCOMUNITU CARE NETWORK
FL487353400OtherDEPARTMENT OF LABOR
FL48224OtherBLUE CROSS BLUE SHIELD
FL271217200Medicaid