Healthcare Provider Details

I. General information

NPI: 1306856828
Provider Name (Legal Business Name): MICHAEL PHILIP BELLEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W FAIRBANKS AVE
WINTER PARK FL
32789-4603
US

IV. Provider business mailing address

1605 W FAIRBANKS AVE
WINTER PARK FL
32789-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0200
  • Fax: 407-975-0209
Mailing address:
  • Phone: 407-975-0200
  • Fax: 407-975-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME101574
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME101574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: