| Michael C. Ianniello, Do | |
|
2560 Judge Fran Jamieson Way Unit 1313 Melbourne FL 32940 | |
| (954) 235-3752 | |
| Not Available |
| Full Name | Michael C. Ianniello, Do |
|---|---|
| Speciality | Internal Medicine |
| Location | 2560 Judge Fran Jamieson Way Unit 1313, Melbourne, Florida |
| Authorized Official Name and Position | Michael Ianniello (OWNER, PHYSICIAN) |
| Authorized Official Contact | 9542353752 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael C. Ianniello, Do 2560 Judge Fran Jamieson Way Unit 1313 Melbourne FL 32940-6199 Ph: (954) 235-3752 | Michael C. Ianniello, Do 2560 Judge Fran Jamieson Way Unit 1313 Melbourne FL 32940 Ph: (954) 235-3752 |
| NPI Number | 1407142425 |
|---|---|
| Provider Enumeration Date | 06/28/2011 |
| Last Update Date | 09/26/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407142425 | NPI | - | NPPES |
| 279400400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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