Provider Demographics
NPI:1801855580
Name:PIAZZA, MICHAEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:PIAZZA
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 1:1011 JEFFORDS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4070
Mailing Address - Country:US
Mailing Address - Phone:727-446-5993
Mailing Address - Fax:727-446-4477
Practice Address - Street 1:1011 JEFFORDS ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4070
Practice Address - Country:US
Practice Address - Phone:727-446-5993
Practice Address - Fax:727-446-4477
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054690207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036356100Medicaid
FL591306865OtherTAX ID NUMBER
FL591306865OtherTAX ID NUMBER
FL08706Medicare PIN