Provider Demographics
NPI:1598717175
Name:DENNIS, MICHAEL A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:DENNIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 100247
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0247
Mailing Address - Country:US
Mailing Address - Phone:352-273-6815
Mailing Address - Fax:352-273-7515
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:BOX 100247
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0247
Practice Address - Country:US
Practice Address - Phone:352-273-6815
Practice Address - Fax:352-273-7515
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 27186208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067198300Medicaid
FL56116YMedicare PIN
FL56116XMedicare PIN
FLD86055Medicare UPIN