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General NPI Number Information
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NPI Number | 1295270775
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Entity Type | Organization
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Legal Business Name | MICHAEL A VENAZIO
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | 8005 BAY ST STE 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3244
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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 | 8005 BAY ST STE 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3244
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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 | OWNER
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Name | DR. MICHAEL A VENAZIO
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Credential | M.D.
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Telephone | 772-388-2110
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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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