MEDICARE: MICHAEL DOERSCH LAT, ATC

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	2255A2300X	Athletic Trainer	1597-39	WI
2	2255A2300X	Athletic Trainer	AL6971	FL

General Provider Information

NPI Number	:	1285041921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DOERSCH LAT, ATC

Provider Business Mailing Address
First Line	:	1526 S BOUNDARY ST
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-8420
Country	:	US
Telephone Number	:	920-660-2536
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 PIRATE NATION WAY
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-9203
Country	:	US
Telephone Number	:	920-660-2536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/24/2023

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Directions to “ MICHAEL DOERSCH LAT, ATC” Practice Location

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