Provider Demographics
NPI:1639149313
Name:TOLENTINO, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3280 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2029
Mailing Address - Country:US
Mailing Address - Phone:727-789-8770
Mailing Address - Fax:727-789-8784
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2029
Practice Address - Country:US
Practice Address - Phone:727-789-8770
Practice Address - Fax:727-789-8784
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-07-21
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME91537207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271110900Medicaid
FL271110900Medicaid