Provider Demographics
NPI:1619080165
Name:ANNUNZIATA, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:ANNUNZIATA
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 1:1676 NEW POINT COMFORT RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4878
Mailing Address - Country:US
Mailing Address - Phone:770-841-1520
Mailing Address - Fax:
Practice Address - Street 1:1676 NEW POINT COMFORT RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4878
Practice Address - Country:US
Practice Address - Phone:770-841-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050123207P00000X
FL084156207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000975895CMedicaid
GA000975895DMedicaid
GAH08832Medicare UPIN
GA000975895CMedicaid
GA000975895BMedicare ID - Type UnspecifiedMEDICAID COBB
GA000975895DMedicaid