Healthcare Provider Details

I. General information

NPI: 1972789261
Provider Name (Legal Business Name): MICHAEL J MARCHESE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 SW 91ST TERRACE SUITE A
GAINESVILLE FL
32608
US

IV. Provider business mailing address

5214 SW 91ST TERRACE SUITE A
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-337-0551
  • Fax: 352-374-2166
Mailing address:
  • Phone: 352-337-0551
  • Fax: 352-374-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J MARCHESE
Title or Position: OWNER
Credential: M.D.
Phone: 352-337-0551