Provider Demographics
NPI:1366499485
Name:MICHAEL A GARVIN, DPM, PA
Entity Type:Organization
Organization Name:MICHAEL A GARVIN, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-335-7171
Mailing Address - Street 1:1791 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5479
Mailing Address - Country:US
Mailing Address - Phone:772-335-7171
Mailing Address - Fax:772-335-2119
Practice Address - Street 1:235 NE 19TH DR
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1933
Practice Address - Country:US
Practice Address - Phone:863-357-1166
Practice Address - Fax:863-357-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0533320002Medicare NSC