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General NPI Number Information
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NPI Number | 1811988165
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Entity Type | Individual
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Provider Name | MICHAEL JOHN PETROCELLI D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 1715 HERITAGE TRL SUITE 204
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City | NAPLES
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State | FL
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Zip | 34112-8715
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Country | US
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Telephone | 239-775-0019
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Fax | 239-775-0219
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Provider Business Mailing Address
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Address Line | 1715 HERITAGE TRL SUITE 204
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City | NAPLES
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State | FL
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Zip | 34112-8715
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Country | US
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Telephone | 239-775-0019
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Fax | 239-775-0219
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO-2399
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License Number State | FL
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