Provider Demographics
NPI:1043261126
Name:VENAZIO, MICHAEL A (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:VENAZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 US HIGHWAY 1 STE 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3899
Mailing Address - Country:US
Mailing Address - Phone:772-388-2110
Mailing Address - Fax:772-388-2426
Practice Address - Street 1:1627 US HIGHWAY 1
Practice Address - Street 2:STE 201
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3462
Practice Address - Country:US
Practice Address - Phone:772-388-2110
Practice Address - Fax:772-388-2426
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG6156Medicare UPIN
FLG61956Medicare UPIN
FL41980Medicare PIN