| Michael P Desouza Md Pa | |
|
2521 Junior St Orange City FL 32763-8000 | |
| (386) 774-5755 | |
| (386) 774-0880 |
| Full Name | Michael P Desouza Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 2521 Junior St, Orange City, Florida |
| Authorized Official Name and Position | Michael Patrick Desouza (PRESIDENT) |
| Authorized Official Contact | 3867745755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael P Desouza Md Pa 2521 Junior St Orange City FL 32763-8000 Ph: (386) 774-5755 | Michael P Desouza Md Pa 2521 Junior St Orange City FL 32763-8000 Ph: (386) 774-5755 |
| NPI Number | 1255678355 |
|---|---|
| Provider Enumeration Date | 01/09/2013 |
| Last Update Date | 04/29/2014 |
| Medicare PECOS PAC ID | 6406088442 |
|---|---|
| Medicare Enrollment ID | O20140407000615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255678355 | NPI | - | NPPES |
| 371723200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0062917 (Florida) | Primary |
| Provider Name | Michael P Desouza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649292020 PECOS PAC ID: 4587614318 Enrollment ID: I20050128000427 |
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