MEDICARE: MICHAEL CAMPANELLI DO

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	174400000X	Specialist	OS8177	FL
2	207T00000X	Neurological Surgery Physician	OS8177	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA5786	OTHER	FL	RAILROAD MEDICARE GROUP NUMBER /LRHSI

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
3	35547	OTHER	FL	BCBS OF FLORIDA
4	1497748743	OTHER		GROUP NPI NUMBER / LRHSI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710931662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CAMPANELLI DO

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 LAKELAND HILLS BLVD
Second Line	:	LAKELAND REGIONAL NEUROSURGICAL ASSOCIATES
City	:	LAKELAND
State	:	FL
Zip	:	33805-4544
Country	:	US
Telephone Number	:	863-603-6542
Fax Number	:	863-603-6529

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/22/2021

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Directions to “ MICHAEL CAMPANELLI DO” Practice Location

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