Provider Demographics
NPI:1184626129
Name:SOMBECK, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SOMBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:
Practice Address - Street 1:210 RINEHART RD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2514
Practice Address - Country:US
Practice Address - Phone:321-843-2100
Practice Address - Fax:321-842-3498
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME563722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124410400Medicaid
FLK9074OtherPTAN
FLFG093AMedicare PIN
FLFG093BMedicare PIN
FLE92982Medicare UPIN