Provider Demographics
NPI:1083108146
Name:OSORIO ACEVEDO, MICHELLE ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:OSORIO ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 BRIGHTON BAY BLVD NE APT 12207
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3479
Mailing Address - Country:US
Mailing Address - Phone:727-688-2982
Mailing Address - Fax:
Practice Address - Street 1:635 4TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2319
Practice Address - Country:US
Practice Address - Phone:727-201-4968
Practice Address - Fax:727-201-4971
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL154463207R00000X, 207RN0300X
PR21854208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty