Provider Demographics
NPI:1366442824
Name:PASTERNAC, MICHAEL (DPM PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PASTERNAC
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4069
Mailing Address - Country:US
Mailing Address - Phone:305-305-5936
Mailing Address - Fax:305-221-2033
Practice Address - Street 1:3626 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4069
Practice Address - Country:US
Practice Address - Phone:305-305-5936
Practice Address - Fax:305-221-2033
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2971213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340369600Medicaid
FLU93818Medicare UPIN
FLU0069CMedicare ID - Type Unspecified
FL340369600Medicaid