MEDICARE: DYLAN JOSEPH CARMICHAEL DO

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	390200000X	Student in an Organized Health Care Education/Training Program		PA
2	208C00000X	Colon & Rectal Surgery Physician	OS23592	FL

General Provider Information

NPI Number	:	1679102941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN JOSEPH CARMICHAEL DO

Provider Business Mailing Address
First Line	:	PO BOX 20800
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4105
Country	:	US
Telephone Number	:	888-402-7256
Fax Number	:	888-402-1099

Provider Business Practice Location Address
First Line	:	900 SE BECKER RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-6641
Country	:	US
Telephone Number	:	772-800-5110
Fax Number	:	772-621-2935

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

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	06/02/2026

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