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NPI Code Detail

MEDICARE: DR. MICHAEL BACIGALUPI O.D.

MEDICARE: DR. MICHAEL BACIGALUPI O.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
1152W00000XOptometrist4770TGTX

General Provider Information

NPI Number : 1386643930
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL BACIGALUPI O.D.
Provider Business Mailing Address
First Line : NOVA SOUTHEASTERN UNIVERSITY
Second Line : 3200 S. UNIVERSITY DRIVE
City : FORT LAUDERDALE
State : FL
Zip : 33316-2018
Country : US
Telephone Number : 954-262-1779
Fax Number : 954-262-3875
Provider Business Practice Location Address
First Line : 3200 S UNIVERSITY DR
Second Line :
City : DAVIE
State : FL
Zip : 33328-2018
Country : US
Telephone Number : 954-262-1779
Fax Number : 954-262-3875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2005
Last Update Date : 07/08/2007

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