Healthcare Provider Details

I. General information

NPI: 1669471959
Provider Name (Legal Business Name): MICHAEL MERCANDETTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 E VENICE AVE UNIT B
VENICE FL
34292-3207
US

IV. Provider business mailing address

1499 E VENICE AVE UNIT B
VENICE FL
34292-3207
US

V. Phone/Fax

Practice location:
  • Phone: 941-584-4039
  • Fax: 941-375-0097
Mailing address:
  • Phone: 941-584-4039
  • Fax: 941-375-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberME64173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: