1346478138 NPI number — DR. MICHAEL J USBERGHI DO

Table of content: DR. MICHAEL J USBERGHI DO (NPI 1346478138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346478138 NPI number — DR. MICHAEL J USBERGHI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
USBERGHI
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1346478138
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 SW 1ST AVENUE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-304-5990
Provider Business Mailing Address Fax Number:
352-304-5993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1431 SW 1ST AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34471-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-304-5990
Provider Business Practice Location Address Fax Number:
540-635-1673
Provider Enumeration Date:
06/30/2009

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: 207Q00000X , with the licence number:  0116021693 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112812100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com