Provider Demographics
NPI:1902802572
Name:DEGNAN, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:DEGNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:181 WEBB DR
Practice Address - Street 2:STE B
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3944
Practice Address - Country:US
Practice Address - Phone:863-419-1235
Practice Address - Fax:863-419-9525
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2018-01-30
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
FLME0015035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04657ZMedicare ID - Type Unspecified
FLD45203Medicare UPIN