MEDICARE: DR. MICHAEL LEON COUSSA MD

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	207P00000X	Emergency Medicine Physician	001208	GA

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	:	1467670844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL LEON COUSSA MD

Provider Business Mailing Address
First Line	:	1401 W SEMINOLE BLVD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-6743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 W SEMINOLE BLVD
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-6743
Country	:	US
Telephone Number	:	407-324-7720
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	05/12/2023

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