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General NPI Number Information
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NPI Number | 1760458152
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Entity Type | Individual
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Provider Name | MICHAEL BRUCE BAND DO
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Gender | Male
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Dates
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Enumeration Date | 02/24/2006
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 2300 E. COUNTY ROAD 540A
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City | LAKELAND
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State | FL
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Zip | 33813-3825
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Country | US
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Telephone | 863-607-3333
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Fax | 866-264-8519
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Provider Business Mailing Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3065
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | OS4899
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License Number State | FL
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