Provider Demographics
NPI:1891052114
Name:FUSTE, MICHAEL ANGELO (CNMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:FUSTE
Suffix:
Gender:M
Credentials:CNMT
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Mailing Address - Street 1:14765 NASSAU SOUND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-4441
Mailing Address - Country:US
Mailing Address - Phone:904-955-0343
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:904-955-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0190952471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology