Provider Demographics
NPI:1902860455
Name:MICHAELOS, LOUIS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:JOHN
Last Name:MICHAELOS
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 1:1030 W BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3225
Mailing Address - Country:US
Mailing Address - Phone:727-585-2200
Mailing Address - Fax:727-584-9239
Practice Address - Street 1:1030 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3225
Practice Address - Country:US
Practice Address - Phone:727-585-2200
Practice Address - Fax:727-584-9239
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME8747207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261116300Medicaid
FL261116300Medicaid
FL52456AMedicare ID - Type Unspecified