Provider Demographics
NPI:1043241375
Name:GERVASI, MICHAEL F (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:GERVASI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4450 S TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3241
Mailing Address - Country:US
Mailing Address - Phone:561-844-9443
Mailing Address - Fax:561-844-1013
Practice Address - Street 1:15858 SW WARFIELD BLVD
Practice Address - Street 2:BOX 648
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-0648
Practice Address - Country:US
Practice Address - Phone:772-597-3596
Practice Address - Fax:772-597-4194
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371600700Medicaid
FL371600700Medicaid
FL80070VMedicare PIN
FL80070TMedicare PIN
FL80070UMedicare PIN
GAE31900Medicare UPIN