| Michael T Reilly Md Pa | |
|
1201 5th Ave N Suite 401 St Petersburg FL 33705-1400 | |
| (727) 821-1132 | |
| (727) 822-2977 |
| Full Name | Michael T Reilly Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1201 5th Ave N, St Petersburg, Florida |
| Authorized Official Name and Position | Michael T Reilly (PRESIDENT) |
| Authorized Official Contact | 7278211132 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael T Reilly Md Pa 1201 5th Ave N Suite 401 St Petersburg FL 33705-1400 Ph: (727) 821-1132 | Michael T Reilly Md Pa 1201 5th Ave N Suite 401 St Petersburg FL 33705-1400 Ph: (727) 821-1132 |
| NPI Number | 1992058358 |
|---|---|
| Provider Enumeration Date | 10/23/2012 |
| Last Update Date | 11/20/2012 |
| Medicare PECOS PAC ID | 6901058346 |
|---|---|
| Medicare Enrollment ID | O20121210000454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992058358 | NPI | - | NPPES |
| 045627600 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME32973 (Florida) | Primary |
| Provider Name | Michael T Reilly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770534240 PECOS PAC ID: 8820980071 Enrollment ID: I20040325000256 |
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