Provider Demographics
NPI:1861677601
Name:LOOK, MICHAEL JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:LOOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HEALTH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-0000
Mailing Address - Country:US
Mailing Address - Phone:904-826-3469
Mailing Address - Fax:904-808-4608
Practice Address - Street 1:199 SOUTH HIGHWAY 17
Practice Address - Street 2:SUITE B
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-0000
Practice Address - Country:US
Practice Address - Phone:904-826-3469
Practice Address - Fax:904-808-4608
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine