Provider Demographics
NPI:1043220221
Name:SEVER PUSATERI & CORTELLI MD PA
Entity Type:Organization
Organization Name:SEVER PUSATERI & CORTELLI MD PA
Other - Org Name:FLORIDA EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUSATERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-972-4444
Mailing Address - Street 1:13602 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4931
Mailing Address - Country:US
Mailing Address - Phone:813-972-4444
Mailing Address - Fax:813-979-1600
Practice Address - Street 1:13602 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4931
Practice Address - Country:US
Practice Address - Phone:813-972-4444
Practice Address - Fax:813-979-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF17666Medicare UPIN
FLI20778Medicare UPIN
FLD53627Medicare UPIN
FLE11889Medicare UPIN