Provider Demographics
NPI:1093742959
Name:MICHAEL K RILEY M D P A
Entity Type:Organization
Organization Name:MICHAEL K RILEY M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-369-0080
Mailing Address - Street 1:3304 SW 34TH CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-3358
Mailing Address - Country:US
Mailing Address - Phone:352-369-0080
Mailing Address - Fax:352-547-2360
Practice Address - Street 1:3304 SW 34TH CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3358
Practice Address - Country:US
Practice Address - Phone:352-369-0080
Practice Address - Fax:352-547-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254551900Medicaid
FL254551900Medicaid
FLQ0000Medicare PIN