Provider Demographics
NPI:1881632495
Name:SASSARIS, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SASSARIS
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 1:3920 BEE RIDGE RD
Mailing Address - Street 2:BLDG. C, SUITE A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1207
Mailing Address - Country:US
Mailing Address - Phone:941-921-6673
Mailing Address - Fax:941-923-8046
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BLDG. C, SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-921-6673
Practice Address - Fax:941-923-8046
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58408Medicare ID - Type Unspecified
FLB89056Medicare UPIN