Healthcare Provider Details

I. General information

NPI: 1982659850
Provider Name (Legal Business Name): MICHAEL L PIVATO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 RESCUE WAY AVIATION MEDICAL CLINIC
CLEARWATER FL
33762
US

IV. Provider business mailing address

15100 RESCUE WAY AVIATION MEDICAL CLINIC
CLEARWATER FL
33762
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax:
Mailing address:
  • Phone: 727-535-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: