Provider Demographics
NPI:1013957166
Name:GARVIN, MICHAEL ALLEN (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:GARVIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5479
Mailing Address - Country:US
Mailing Address - Phone:772-335-7171
Mailing Address - Fax:772-335-2119
Practice Address - Street 1:1791 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5479
Practice Address - Country:US
Practice Address - Phone:772-335-7171
Practice Address - Fax:772-335-2119
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1984213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052018700Medicaid
FL65120TMedicare UPIN
FLT37314Medicare UPIN
FL052018700Medicaid