MEDICARE: MR. MICHAEL ANTHONY SPOSATO PA-C

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	363A00000X	Physician Assistant	000066	CT

General Provider Information

NPI Number	:	1548271463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY SPOSATO PA-C

Provider Business Mailing Address
First Line	:	98 MAIN ST STE 301
Second Line	:	MIDSTATE MEDICAL GROUP
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2500
Country	:	US
Telephone Number	:	860-621-6704
Fax Number	:	860-620-0446

Provider Business Practice Location Address
First Line	:	98 MAIN ST
Second Line	:	MIDSTATE MEDICAL GROUP
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2500
Country	:	US
Telephone Number	:	860-621-6704
Fax Number	:	860-620-0446

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	05/16/2012

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