=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457874414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. MICHAEL A. NOCERO JR. MD MACC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2017
-----------------------------------------------------
Last Update Date | 07/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 E ALTAMONTE DR
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32701-4823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-262-0966
-----------------------------------------------------
Fax | 407-951-6364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 SATSUMA DR
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32714-6505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-760-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MICHAEL A NOCERO JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-760-1703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------