Healthcare Provider Details

I. General information

NPI: 1679102941
Provider Name (Legal Business Name): DYLAN JOSEPH CARMICHAEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE BECKER RD
PORT SAINT LUCIE FL
34984-6641
US

IV. Provider business mailing address

PO BOX 20800
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 772-800-5110
  • Fax: 772-621-2935
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-402-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberOS23592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: