Provider Demographics
NPI:1164168720
Name:DEGNAN, MICHAEL ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:DEGNAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 CREST DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-9330
Mailing Address - Country:US
Mailing Address - Phone:863-224-0809
Mailing Address - Fax:
Practice Address - Street 1:39000 BOB HOPE DR.,
Practice Address - Street 2:ACHS-GME OFFICE STE. 201,
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-773-4504
Practice Address - Fax:760-837-8581
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program