Provider Demographics
NPI:1376783407
Name:MICHAEL MERCANDETTI MD PA
Entity Type:Organization
Organization Name:MICHAEL MERCANDETTI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCANDETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-584-4039
Mailing Address - Street 1:1499 E VENICE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3207
Mailing Address - Country:US
Mailing Address - Phone:941-584-4039
Mailing Address - Fax:941-375-0097
Practice Address - Street 1:1499 E VENICE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3207
Practice Address - Country:US
Practice Address - Phone:941-584-4039
Practice Address - Fax:941-375-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25937AMedicare PIN