MEDICARE: DR. MICHAEL SORBELLO 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	2085R0202X	Diagnostic Radiology Physician	OS0006632	FL
2	2085R0202X	Diagnostic Radiology Physician	OS6632	FL
3	2085B0100X	Body Imaging Physician	OS6632	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300038677	OTHER	FL	RR MEDICARE
3	P00467234	OTHER	FL	RR MEDICARE
5	P00467234	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	80831	OTHER	FL	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730138793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SORBELLO DO

Provider Business Mailing Address
First Line	:	PO BOX 3148
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-3148
Country	:	US
Telephone Number	:	855-206-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 N WASHINGTON AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2163
Country	:	US
Telephone Number	:	321-268-6192
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	09/28/2015

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Directions to “ DR. MICHAEL SORBELLO DO” Practice Location

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