Provider Demographics
NPI:1619290996
Name:MICHAEL P. SASSARIS, M.D. PA
Entity Type:Organization
Organization Name:MICHAEL P. SASSARIS, M.D. 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:P
Authorized Official - Last Name:SASSARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-921-6673
Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:BLDG. C, SUITE A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1207
Mailing Address - Country:US
Mailing Address - Phone:941-921-6673
Mailing Address - Fax:941-923-8046
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BLDG. C, SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-921-6673
Practice Address - Fax:941-923-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB89056Medicare UPIN