Healthcare Provider Details

I. General information

NPI: 1255877981
Provider Name (Legal Business Name): MICHAEL P TEEPE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S. HARBOR CITY BLVD SUITE 420
MELBOURNE FL
32901
US

IV. Provider business mailing address

2222 S. HARBOR CITY BLVD SUITE 420
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-768-9914
  • Fax: 321-953-1893
Mailing address:
  • Phone: 321-768-9914
  • Fax: 321-953-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102926
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9110026
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9110026
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: