Healthcare Provider Details

I. General information

NPI: 1730851650
Provider Name (Legal Business Name): MICHAEL CORNUTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1366 PINEHURST DR
SPRING HILL FL
34606-4500
US

IV. Provider business mailing address

21729 BILLOWY JAUNT DR
LAND O LAKES FL
34637-7633
US

V. Phone/Fax

Practice location:
  • Phone: 352-684-0522
  • Fax:
Mailing address:
  • Phone: 585-314-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: