Provider Demographics
NPI:1285610915
Name:PESCASIO, MICHELE D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:D
Last Name:PESCASIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10311 CROSS CREEK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2989
Mailing Address - Country:US
Mailing Address - Phone:813-907-9898
Mailing Address - Fax:813-907-0220
Practice Address - Street 1:10311 CROSS CREEK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2989
Practice Address - Country:US
Practice Address - Phone:813-907-9898
Practice Address - Fax:813-907-0220
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME95246207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274739100Medicaid
FL41002OtherBLUE CROSS BLUE SHIELD
FLP00405619Medicare PIN
FL274739100Medicaid
FL41002YMedicare PIN
FLG83941Medicare UPIN