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1285845552

NPI Code Detail

MEDICARE: MICHAEL M. LIDDY MD

MEDICARE: MICHAEL M. LIDDY MD

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	207L00000X	Anesthesiology Physician	2024042416	MO
2	207L00000X	Anesthesiology Physician	01091926A	IN
3	207L00000X	Anesthesiology Physician	ME110099	FL
4	207L00000X	Anesthesiology Physician	W1624	TX
5	207L00000X	Anesthesiology Physician	79070	AZ

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	14F6M	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285845552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL M. LIDDY MD

Provider Business Mailing Address
First Line	:	1261 S TAMIAMI TRL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-2219
Country	:	US
Telephone Number	:	941-366-1164
Fax Number	:	941-366-3123

Provider Business Practice Location Address
First Line	:	8075 N SHADELAND AVE STE 330
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2694
Country	:	US
Telephone Number	:	317-355-7220
Fax Number	:

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	01/19/2026

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Directions to “ MICHAEL M. LIDDY MD” Practice Location

Language	Start Address	Practice Location

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