Provider Demographics
NPI:1831191428
Name:FLOSI, MICHAEL EGO (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EGO
Last Name:FLOSI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 NW PEACOCK BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2271
Mailing Address - Country:US
Mailing Address - Phone:772-446-4883
Mailing Address - Fax:772-446-4875
Practice Address - Street 1:7710 SOUTH US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2320
Practice Address - Country:US
Practice Address - Phone:772-335-5300
Practice Address - Fax:772-878-7602
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
U4985ZMedicare ID - Type Unspecified
FLP73348Medicare UPIN