Healthcare Provider Details

I. General information

NPI: 1962822999
Provider Name (Legal Business Name): MICHAEL SACO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 BRUCE B DOWNS BLVD
TAMPA FL
33612-9211
US

IV. Provider business mailing address

12210 BRUCE B DOWNS BLVD
TAMPA FL
33612-9211
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax:
Mailing address:
  • Phone: 813-972-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME125985
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME125985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: