Provider Demographics
NPI:1740280122
Name:TONNER, MICHAEL P (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:TONNER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12920 US HIGHWAY 1 STE A
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3772
Mailing Address - Country:US
Mailing Address - Phone:772-388-8322
Mailing Address - Fax:772-388-8323
Practice Address - Street 1:12920 US HIGHWAY 1 STE A
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3772
Practice Address - Country:US
Practice Address - Phone:772-388-8322
Practice Address - Fax:772-388-8323
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064234174400000X, 207RP1001X
NHLT-4241207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112583400Medicaid
FL373709800Medicaid
FL23051AMedicare PIN
FLE68695Medicare UPIN