Healthcare Provider Details

I. General information

NPI: 1407018138
Provider Name (Legal Business Name): MICHELLE S PAGE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4288 WOODBINE RD
PACE FL
32571-8755
US

IV. Provider business mailing address

4288 WOODBINE RD
PACE FL
32571-8755
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-8600
  • Fax: 850-995-9070
Mailing address:
  • Phone: 850-995-8600
  • Fax: 850-995-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE S. PAGE
Title or Position: PRESIDENT
Credential: MD
Phone: 850-995-8600