Healthcare Provider Details

I. General information

NPI: 1851825145
Provider Name (Legal Business Name): MICHAEL LOUIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 EVELYN BYRD AVE
HARRISONBURG VA
22801-3487
US

IV. Provider business mailing address

201 14TH ST SW
LARGO FL
33770-3133
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102207921
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102207921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: