Provider Demographics
NPI:1528024155
Name:PAGANI, MICHAEL KENNETH (AP LMT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:PAGANI
Suffix:
Gender:M
Credentials:AP LMT
Other - Prefix:
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Mailing Address - Street 1:1790 POMERO DRIVE
Mailing Address - Street 2:BILLING DEPT
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2716
Mailing Address - Country:US
Mailing Address - Phone:941-493-8596
Mailing Address - Fax:941-496-8515
Practice Address - Street 1:3522 WEST AZECLE STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-998-9200
Practice Address - Fax:941-496-8515
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP916171100000X
FLMA7397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C0425Medicare UPIN
C5238Medicare UPIN