MEDICARE: DR. MICHAEL FRANCIS TREVISANI 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	208C00000X	Colon & Rectal Surgery Physician	ME0050918	FL

General Provider Information

NPI Number	:	1861483935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL FRANCIS TREVISANI M.D.

Provider Business Mailing Address
First Line	:	2802 ALOMA AVE
Second Line	:	SUITE 101
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3532
Country	:	US
Telephone Number	:	407-628-1950
Fax Number	:	407-645-2277

Provider Business Practice Location Address
First Line	:	2802 ALOMA AVE
Second Line	:	SUITE 101
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3532
Country	:	US
Telephone Number	:	407-628-1950
Fax Number	:	407-645-2277

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/08/2007

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