Provider Demographics
NPI:1447264940
Name:MARCHESE, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MARCHESE
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 1:5214 SW 91ST TER STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7148
Mailing Address - Country:US
Mailing Address - Phone:352-337-0551
Mailing Address - Fax:352-374-2166
Practice Address - Street 1:5214 SW 91ST TER STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7148
Practice Address - Country:US
Practice Address - Phone:352-337-0551
Practice Address - Fax:352-374-2166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC290032084P0800X
FLME482322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D62436Medicare UPIN
42209Medicare ID - Type Unspecified