MEDICARE: DR. MICHELE D. PESCASIO M.D.

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	207Q00000X	Family Medicine Physician	ME95246	FL
2	207QS0010X	Sports Medicine (Family Medicine) Physician	ME95246	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
2	41002	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1285610915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE D. PESCASIO M.D.

Provider Business Mailing Address
First Line	:	10311 CROSS CREEK BLVD
Second Line	:	SUITE E
City	:	TAMPA
State	:	FL
Zip	:	33647-2989
Country	:	US
Telephone Number	:	813-907-9898
Fax Number	:	813-907-0220

Provider Business Practice Location Address
First Line	:	10311 CROSS CREEK BLVD
Second Line	:	SUITE E
City	:	TAMPA
State	:	FL
Zip	:	33647-2989
Country	:	US
Telephone Number	:	813-907-9898
Fax Number	:	813-907-0220

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	05/03/2017

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