Provider Demographics
NPI:1437101359
Name:WANGER, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:WANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1007 JEFFORDS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4082
Mailing Address - Country:US
Mailing Address - Phone:727-461-7908
Mailing Address - Fax:727-223-5269
Practice Address - Street 1:516 LAKEVIEW RD
Practice Address - Street 2:BLDG 4
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3302
Practice Address - Country:US
Practice Address - Phone:727-461-7908
Practice Address - Fax:727-223-5269
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0072212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110159498OtherRAILROAD MEDICARE
FL110159498OtherRAILROAD MEDICARE
FL41362ZMedicare PIN
FL263255100Medicaid