Provider Demographics
NPI:1407067838
Name:PENNACHIO & FISHMAN M.D., P.A.
Entity Type:Organization
Organization Name:PENNACHIO & FISHMAN M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNACHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-394-7137
Mailing Address - Street 1:14244 STATE ROAD 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8003
Mailing Address - Country:US
Mailing Address - Phone:352-394-7137
Mailing Address - Fax:
Practice Address - Street 1:14244 STATE ROAD 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8003
Practice Address - Country:US
Practice Address - Phone:352-394-7137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1324Medicare ID - Type Unspecified