Provider Demographics
NPI:1043207640
Name:MICHAEL JON RINALDI DO PA
Entity Type:Organization
Organization Name:MICHAEL JON RINALDI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RINALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-983-7778
Mailing Address - Street 1:5230 WILLING ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4971
Mailing Address - Country:US
Mailing Address - Phone:850-983-7778
Mailing Address - Fax:850-983-7785
Practice Address - Street 1:150 E REDSTONE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5357
Practice Address - Country:US
Practice Address - Phone:850-983-7778
Practice Address - Fax:850-983-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7850207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271433700Medicaid
FL271433700Medicaid
FLK6907Medicare PIN