Provider Demographics
NPI:1427211903
Name:FLEISS, MICHAEL M (RT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:FLEISS
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 KINSMERE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4522
Mailing Address - Country:US
Mailing Address - Phone:727-376-2792
Mailing Address - Fax:
Practice Address - Street 1:1716 KINSMERE DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4522
Practice Address - Country:US
Practice Address - Phone:727-376-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT 72753247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist