Provider Demographics
NPI:1851353239
Name:MICHAELOS, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:MICHAELOS
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 1:1030 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3225
Mailing Address - Country:US
Mailing Address - Phone:727-585-2200
Mailing Address - Fax:727-584-9239
Practice Address - Street 1:1030 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3225
Practice Address - Country:US
Practice Address - Phone:727-585-2200
Practice Address - Fax:727-584-9239
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68672207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27298OtherBCBS FLORIDA PROVIDER ID
FL379316800Medicaid
FL0797481OtherAETNA PROVIDER ID
FL27298AMedicare PIN
FL27298OtherBCBS FLORIDA PROVIDER ID