Provider Demographics
NPI:1053553354
Name:MICHAEL DATTOLI PLC
Entity type:Organization
Organization Name:MICHAEL DATTOLI PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DATTOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-957-4926
Mailing Address - Street 1:2803 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5344
Mailing Address - Country:US
Mailing Address - Phone:941-957-4926
Mailing Address - Fax:941-957-0038
Practice Address - Street 1:2803 FRUITVILLE ROAD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5344
Practice Address - Country:US
Practice Address - Phone:941-957-4926
Practice Address - Fax:941-957-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058562174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBP686AMedicare PIN
FLE62996Medicare UPIN