Provider Demographics
NPI:1487821526
Name:MICHAEL G FOLEY MD PA
Entity Type:Organization
Organization Name:MICHAEL G FOLEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-682-6143
Mailing Address - Street 1:524 JAMES LEE BLVD W
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536
Mailing Address - Country:US
Mailing Address - Phone:850-682-6143
Mailing Address - Fax:850-682-0227
Practice Address - Street 1:524 JAMES LEE BLVD W
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536
Practice Address - Country:US
Practice Address - Phone:850-682-6143
Practice Address - Fax:850-682-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059459800Medicaid
FL46112OtherBCBS PIN
FLD54950Medicare UPIN
FL059459800Medicaid