Healthcare Provider Details

I. General information

NPI: 1972531226
Provider Name (Legal Business Name): MICHAEL J DALLOLIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

4001 SW 13TH ST
GAINESVILLE FL
32608-3513
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-4900
  • Fax: 352-294-9887
Mailing address:
  • Phone: 352-265-5549
  • Fax: 352-265-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39314
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10814
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number10814
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: