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General NPI Number Information
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NPI Number | 1043261126
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Entity Type | Individual
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Provider Name | MICHAEL A. VENAZIO MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 1627 US HIGHWAY 1 STE 201
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City | SEBASTIAN
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State | FL
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Zip | 32958-3462
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Country | US
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Telephone | 772-388-2110
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Fax | 772-388-2426
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Provider Business Mailing Address
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Address Line | 1627 US HIGHWAY 1 STE 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3899
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Country | US
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Telephone | 772-388-2110
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Fax | 772-388-2426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME73001
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License Number State | FL
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