Provider Demographics
NPI:1992017198
Name:FABER, CRISTIANO NICOLETTI (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTIANO
Middle Name:NICOLETTI
Last Name:FABER
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 1:180 JFK DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6641
Mailing Address - Country:US
Mailing Address - Phone:561-548-4900
Mailing Address - Fax:561-434-5165
Practice Address - Street 1:5301 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1149
Practice Address - Country:US
Practice Address - Phone:561-548-4900
Practice Address - Fax:561-434-5165
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107141208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDX909XWOtherMEDICARE
FL003504000OtherMEDICAID