MEDICARE: MR. MICHAEL L FUNK PA-C

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	363A00000X	Physician Assistant	PA3246	FL

General Provider Information

NPI Number	:	1386659126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL L FUNK PA-C

Provider Business Mailing Address
First Line	:	5638 DEWBERRY WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-4501
Country	:	US
Telephone Number	:	561-682-9168
Fax Number	:

Provider Business Practice Location Address
First Line	:	5638 DEWBERRY WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-4501
Country	:	US
Telephone Number	:	561-682-9168
Fax Number	:

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	09/10/2008

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