MEDICARE: MICHAEL A CROMER 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	ME0050973	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	:	1326006081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A CROMER M.D.

Provider Business Mailing Address
First Line	:	15320 AMBERLY DR
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33647-1647
Country	:	US
Telephone Number	:	813-977-0733
Fax Number	:	813-971-2230

Provider Business Practice Location Address
First Line	:	4278 W LINEBAUGH AVE
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-960-3321
Fax Number	:	813-264-7532

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/28/2014

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