Provider Demographics
NPI:1659432037
Name:MICHAEL DEMNER, DPM, INC.
Entity Type:Organization
Organization Name:MICHAEL DEMNER, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-391-1913
Mailing Address - Street 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:STE.350
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1251
Mailing Address - Country:US
Mailing Address - Phone:727-391-1913
Mailing Address - Fax:727-319-2713
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:STE.350
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1251
Practice Address - Country:US
Practice Address - Phone:727-391-1913
Practice Address - Fax:727-319-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1338213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4357510001Medicare NSC
FLT55512Medicare UPIN