1710931662 NPI number — MICHAEL CAMPANELLI DO

Table of content: MICHAEL CAMPANELLI DO (NPI 1710931662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710931662 NPI number — MICHAEL CAMPANELLI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPANELLI
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710931662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 917770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32891-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 LAKELAND HILLS BLVD
Provider Second Line Business Practice Location Address:
LAKELAND REGIONAL NEUROSURGICAL ASSOCIATES
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33805-4544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-603-6542
Provider Business Practice Location Address Fax Number:
863-603-6529
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OS8177 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: OS8177 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 260171100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA5786 . This is a "RAILROAD MEDICARE GROUP NUMBER /LRHSI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 35547 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1497748743 . This is a "GROUP NPI NUMBER / LRHSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260171100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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