Provider Demographics
NPI:1295270775
Name:MICHAEL A VENAZIO
Entity type:Organization
Organization Name:MICHAEL A VENAZIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VENAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-388-2110
Mailing Address - Street 1:8005 BAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3244
Mailing Address - Country:US
Mailing Address - Phone:772-388-2110
Mailing Address - Fax:772-388-2426
Practice Address - Street 1:8005 BAY ST STE 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3244
Practice Address - Country:US
Practice Address - Phone:772-388-2110
Practice Address - Fax:772-388-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
41980Medicare PIN
G61956Medicare UPIN