Healthcare Provider Details

I. General information

NPI: 1205454071
Provider Name (Legal Business Name): MICHAEL J GALLUZI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

7 CENTRAL PARK AVE
OLD ORCHARD BEACH ME
04064-2505
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number734149
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA223062
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: