Provider Demographics
NPI:1124066402
Name:SFORZINI, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SFORZINI
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 1:753 CO RD 466
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-268-0003
Mailing Address - Fax:855-642-0650
Practice Address - Street 1:753 CO RD 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-268-0003
Practice Address - Fax:855-642-0650
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16569207R00000X
ALMD.16569208M00000X
FL138984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009924830Medicaid
AL51094565OtherBCBS
AL04-11590OtherUNITED HEALTHCARE
AL51094568OtherBCBS
AL009924830Medicaid
F31618Medicare UPIN
AL110206722Medicare ID - Type UnspecifiedRAILROAD PGBA
AL000094568Medicare ID - Type Unspecified
AL000094565Medicare ID - Type Unspecified