MEDICARE: MICHAEL PETIT-HOMME

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	343900000X	Non-emergency Medical Transport (VAN)		FL

General Provider Information

NPI Number	:	1730043605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PETIT-HOMME

Provider Business Mailing Address
First Line	:	7830 LAKE WILSON RD # 204
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-9605
Country	:	US
Telephone Number	:	855-505-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	7830 LAKE WILSON RD # 204
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-9605
Country	:	US
Telephone Number	:	855-505-0406
Fax Number	:

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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