Healthcare Provider Details

I. General information

NPI: 1801855580
Provider Name (Legal Business Name): MICHAEL ROBERT PIAZZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 JEFFORDS ST SUITE C
CLEARWATER FL
33756-4070
US

IV. Provider business mailing address

1011 JEFFORDS ST SUITE C
CLEARWATER FL
33756-4070
US

V. Phone/Fax

Practice location:
  • Phone: 727-446-5993
  • Fax: 727-446-4477
Mailing address:
  • Phone: 727-446-5993
  • Fax: 727-446-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME0054690
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0054690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: