Healthcare Provider Details

I. General information

NPI: 1710104583
Provider Name (Legal Business Name): MICHAEL T. MCCORMICK & ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SHAMROCK BLVD
VENICE FL
34293-1630
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 941-493-8666
  • Fax: 941-497-5411
Mailing address:
  • Phone: 941-493-8666
  • Fax: 941-497-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROY CLINT LAIRD
Title or Position: OWNER AND DPM
Credential:
Phone: 941-493-8666