Provider Demographics
NPI:1669471959
Name:MERCANDETTI, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MERCANDETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 E VENICE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3207
Mailing Address - Country:US
Mailing Address - Phone:941-584-4039
Mailing Address - Fax:941-375-0097
Practice Address - Street 1:1499 E VENICE AVE UNIT B
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3207
Practice Address - Country:US
Practice Address - Phone:941-584-4039
Practice Address - Fax:941-375-0097
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64173207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25937AMedicare PIN
FLF89985Medicare UPIN