Provider Demographics
NPI:1417063769
Name:BARANAUSKAS, MICHAEL V (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:BARANAUSKAS
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 1:131 S PEBBLE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5791
Mailing Address - Country:US
Mailing Address - Phone:813-535-6441
Mailing Address - Fax:813-605-6149
Practice Address - Street 1:131 S PEBBLE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5791
Practice Address - Country:US
Practice Address - Phone:813-535-6441
Practice Address - Fax:813-605-6149
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME153164207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113482400Medicaid
G74097Medicare UPIN
OH4018446Medicare PIN