MEDICARE: MR. MICHAEL ANTHONY PAMMIT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301099314	MI
2	207V00000X	Obstetrics & Gynecology Physician	ME132857	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194012732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY PAMMIT M.D.

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD STE 400
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-262-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	11945 SAN JOSE BLVD STE 400
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-262-5333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2011
Last Update Date	:	08/05/2021

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Directions to “ MR. MICHAEL ANTHONY PAMMIT M.D.” Practice Location

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