Provider Demographics
NPI:1487660247
Name:SAINT PETERSBURG NEUROLOGY CLINIC
Entity Type:Organization
Organization Name:SAINT PETERSBURG NEUROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-820-7701
Mailing Address - Street 1:1099 5TH AVE N
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1469
Mailing Address - Country:US
Mailing Address - Phone:727-820-7701
Mailing Address - Fax:727-820-7700
Practice Address - Street 1:SAINT PETERSBURG NEUROLOGY CLINIC
Practice Address - Street 2:1099 5TH AVE. N. STE 300
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1419
Practice Address - Country:US
Practice Address - Phone:727-820-7701
Practice Address - Fax:727-820-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45463OtherMEDICARE ID
FL274770700Medicaid
FL33705A001OtherTRICARE
FL2011453OtherUNITED HEALTH CARE
FL45463OtherBSBC
FLCH3830OtherMEDICARE RAILROAD
FL=========OtherEVERCARE
FL45463OtherMEDICARE ID
FL45463Medicare PIN