Provider Demographics
NPI:1710931662
Name:CAMPANELLI, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CAMPANELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 LAKELAND HILLS BLVD
Practice Address - Street 2:LAKELAND REGIONAL NEUROSURGICAL ASSOCIATES
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4544
Practice Address - Country:US
Practice Address - Phone:863-603-6542
Practice Address - Fax:863-603-6529
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8177174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260171100Medicaid
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER /LRHSI
FL35547OtherBCBS OF FLORIDA
1497748743OtherGROUP NPI NUMBER / LRHSI
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER /LRHSI
FL35547OtherBCBS OF FLORIDA
FL35547XMedicare PIN