Provider Demographics
NPI:1083355846
Name:NIEDERBRACH, MICHAEL GENE JR
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GENE
Last Name:NIEDERBRACH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4815
Mailing Address - Country:US
Mailing Address - Phone:727-893-6116
Mailing Address - Fax:727-553-7340
Practice Address - Street 1:1800 66TH ST N STE 220
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8747
Practice Address - Country:US
Practice Address - Phone:727-893-6323
Practice Address - Fax:727-893-6324
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME168138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine