Provider Demographics
NPI:1306856828
Name:BELLEW, MICHAEL PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PHILIP
Last Name:BELLEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4603
Mailing Address - Country:US
Mailing Address - Phone:407-975-0200
Mailing Address - Fax:407-975-0209
Practice Address - Street 1:1605 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4603
Practice Address - Country:US
Practice Address - Phone:407-975-0200
Practice Address - Fax:407-975-0209
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1015742085R0204X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101574OtherFLORIDA MEDICAL LICENSE
FLME101574OtherFLORIDA MEDICAL LICENSE
FLAL524YMedicare PIN