Provider Demographics
NPI:1528024155
Name:PAGANI, MICHAEL KENNETH (AP LMT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:PAGANI
Suffix:
Gender:M
Credentials:AP LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 POMERO DRIVE
Mailing Address - Street 2:BILLING DEPT
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2716
Mailing Address - Country:US
Mailing Address - Phone:941-493-8596
Mailing Address - Fax:941-496-8515
Practice Address - Street 1:3522 WEST AZECLE STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-998-9200
Practice Address - Fax:941-496-8515
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP916171100000X
FLMA7397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C0425Medicare UPIN
C5238Medicare UPIN