MEDICARE: GERALD MICELI 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	207R00000X	Internal Medicine Physician	ME62517	FL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME62517	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25294W	OTHER	FL	MEDICARE ID
4	460003874	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ME62517	OTHER	FL	VHN
3	25294	OTHER	FL	BCBS
5	ME62517	OTHER	FL	UHC
6	ME62517	OTHER	FL	UNITED BENEFITS

General Provider Information

NPI Number	:	1396705570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD MICELI M.D.

Provider Business Mailing Address
First Line	:	300 CLYDE MORRIS BLVD STE A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5909
Country	:	US
Telephone Number	:	386-317-8620
Fax Number	:	386-317-8625

Provider Business Practice Location Address
First Line	:	300 CLYDE MORRIS BLVD STE A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5909
Country	:	US
Telephone Number	:	386-317-8620
Fax Number	:	386-317-8625

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/17/2023

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Directions to “ GERALD MICELI M.D.” Practice Location

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