Provider Demographics
NPI:1154390532
Name:RETINO, MICHAEL ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:RETINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 4TH AVE E STE 4
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1043
Mailing Address - Country:US
Mailing Address - Phone:941-226-8844
Mailing Address - Fax:941-226-8845
Practice Address - Street 1:201 4TH AVE E STE 4
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1043
Practice Address - Country:US
Practice Address - Phone:941-226-8844
Practice Address - Fax:941-226-8845
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16386207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105015500Medicaid
OH4278491Medicare PIN
OHG11523Medicare UPIN