Healthcare Provider Details

I. General information

NPI: 1972882777
Provider Name (Legal Business Name): MICHAEL JOS SWEENEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 GRAND AVE
JACKSONVILLE FL
32210-4405
US

IV. Provider business mailing address

2917 GRAND AVE
JACKSONVILLE FL
32210-4405
US

V. Phone/Fax

Practice location:
  • Phone: 904-247-4220
  • Fax:
Mailing address:
  • Phone: 904-388-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME 42000
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD.014985
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: