Healthcare Provider Details

I. General information

NPI: 1912969072
Provider Name (Legal Business Name): MICHELLE LEON SALVAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD MS3075
TAMPA FL
33607-6307
US

IV. Provider business mailing address

3003 W DR MLK JR BLVD 4TH FLOOR
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4933
  • Fax: 813-870-4887
Mailing address:
  • Phone: 813-870-4421
  • Fax: 813-870-4390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME92933
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 92933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: