Provider Demographics
NPI:1740215193
Name:DONOHOE, MICHAEL JOS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOS
Last Name:DONOHOE
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 1:685 PEACHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-738-5300
Mailing Address - Fax:386-738-9537
Practice Address - Street 1:685 PEACHWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-738-5300
Practice Address - Fax:386-738-9537
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048443208600000X, 2086S0129X
FLME50312208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045509100Medicaid
FL045509100Medicaid
FL03675Medicare PIN