Provider Demographics
NPI:1700848652
Name:SPITAL, MICHAEL DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:SPITAL
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 1:8925 SW 148TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8000
Mailing Address - Country:US
Mailing Address - Phone:305-969-1677
Mailing Address - Fax:305-969-1699
Practice Address - Street 1:8925 SW 148TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-8000
Practice Address - Country:US
Practice Address - Phone:305-969-1677
Practice Address - Fax:305-969-1699
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63778Medicare UPIN