Healthcare Provider Details

I. General information

NPI: 1740280122
Provider Name (Legal Business Name): MICHAEL P TONNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12920 US HIGHWAY 1 STE A
SEBASTIAN FL
32958-3772
US

IV. Provider business mailing address

12920 US HIGHWAY 1 STE A
SEBASTIAN FL
32958-3772
US

V. Phone/Fax

Practice location:
  • Phone: 772-388-8322
  • Fax: 772-388-8323
Mailing address:
  • Phone: 772-388-8322
  • Fax: 772-388-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0064234
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberLT-4241
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME0064234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: