Provider Demographics
NPI:1225030620
Name:MICHELMAN, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:MICHELMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1201 5TH AVE N
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1455
Mailing Address - Country:US
Mailing Address - Phone:727-821-8194
Mailing Address - Fax:727-502-8861
Practice Address - Street 1:303 PINELLAS ST
Practice Address - Street 2:SUITE 330
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3809
Practice Address - Country:US
Practice Address - Phone:727-447-8100
Practice Address - Fax:727-461-2603
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME21517207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL326383900Medicaid
FL830003872OtherMEDICARE RR
78042OtherBLUE CROSS / BLUE SHIELD
FL830003872OtherMEDICARE RR
FL326383900Medicaid
FL78042YMedicare PIN