Provider Demographics
NPI:1902992456
Name:SPUZA MILORD, MICHELLE S (MD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:S
Last Name:SPUZA MILORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708
Mailing Address - Country:US
Mailing Address - Phone:727-319-4535
Mailing Address - Fax:727-319-4528
Practice Address - Street 1:5100 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708
Practice Address - Country:US
Practice Address - Phone:727-319-4535
Practice Address - Fax:727-319-4528
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME061160207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14343OtherBCBS
FL14343YMedicare PIN
F08123Medicare UPIN