Physician Compare National (NPI:1720043722)

HEALTHCARE PROVIDER: MICHAEL DAVID PENTICUFF PH.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1720043722
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1456401751
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091116000239
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PENTICUFF
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1707 ENFIELD RD
	Group Practice or individual's line 1 address
Line 2 Street Address	MICHAEL PENTICUFF PH D
	Group Practice or individual's line 2 address
City	AUSTIN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	787033308
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5124549300
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y