Healthcare Provider Details

I. General information

NPI: 1639149313
Provider Name (Legal Business Name): MICHAEL J TOLENTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 N MCMULLEN BOOTH RD SUITE 120
CLEARWATER FL
33761-2029
US

IV. Provider business mailing address

3280 N MCMULLEN BOOTH RD SUITE 120
CLEARWATER FL
33761-2029
US

V. Phone/Fax

Practice location:
  • Phone: 727-789-8770
  • Fax: 727-789-8784
Mailing address:
  • Phone: 727-789-8770
  • Fax: 727-789-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME91537
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME91537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: