Provider Demographics
NPI:1861483935
Name:TREVISANI, MICHAEL FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:TREVISANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2802 ALOMA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3532
Mailing Address - Country:US
Mailing Address - Phone:407-628-1950
Mailing Address - Fax:407-645-2277
Practice Address - Street 1:2802 ALOMA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3532
Practice Address - Country:US
Practice Address - Phone:407-628-1950
Practice Address - Fax:407-645-2277
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0050918208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10653Medicare ID - Type Unspecified
FLE51914Medicare UPIN