MEDICARE: DR. MICHAEL BRUCCULERI 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	207RN0300X	Nephrology Physician	94479	FL

General Provider Information

NPI Number	:	1346271145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BRUCCULERI M.D.

Provider Business Mailing Address
First Line	:	14134 NEPHRON LN
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-6504
Country	:	US
Telephone Number	:	727-863-5418
Fax Number	:	727-869-8626

Provider Business Practice Location Address
First Line	:	1055 S FORT HARRISON AVE
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3905
Country	:	US
Telephone Number	:	727-442-6245
Fax Number	:	727-447-3793

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/09/2016

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