Provider Demographics
NPI:1821067968
Name:DURANTE, MICHAEL V (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:V
Last Name:DURANTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 W DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6315
Mailing Address - Country:US
Mailing Address - Phone:352-787-2785
Mailing Address - Fax:352-787-4484
Practice Address - Street 1:1235 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6315
Practice Address - Country:US
Practice Address - Phone:352-787-2785
Practice Address - Fax:352-787-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381397500Medicaid
FL350055849OtherRAILROAD MEDICARE
FL70930OtherBLUE CROSS BLUE SHIELD
FLU20066Medicare UPIN
FL381397500Medicaid