Provider Demographics
NPI:1811000888
Name:DILLEHAY, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:DILLEHAY
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 1:100 WAYMONT COURT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3501
Mailing Address - Country:US
Mailing Address - Phone:407-688-8862
Mailing Address - Fax:407-688-8868
Practice Address - Street 1:100 WAYMONT CT
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3412
Practice Address - Country:US
Practice Address - Phone:407-688-8862
Practice Address - Fax:407-688-8868
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5386409OtherAETNA
FL51293OtherBLUE CROSS BLUE SHIELD
FL261861300Medicaid
FL261861300Medicaid
FL51293ZMedicare ID - Type Unspecified