MEDICARE: MICHAEL BESSOS MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME 57532	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255443859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL BESSOS MD PA

Provider Business Mailing Address
First Line	:	2632 SW PORT ST LUCIE BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2845
Country	:	US
Telephone Number	:	772-878-3990
Fax Number	:	772-878-9520

Provider Business Practice Location Address
First Line	:	2632 SW PORT ST LUCIE BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2845
Country	:	US
Telephone Number	:	772-878-3990
Fax Number	:	772-878-9520

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL BESSOS
Credential	:	M.D.
Telephone Number	:	772-878-3990

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/23/2008

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Directions to “MICHAEL BESSOS MD PA ” Practice Location

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