Provider Demographics
NPI:1528246220
Name:MICHAEL J TORTORELLA MD PA
Entity type:Organization
Organization Name:MICHAEL J TORTORELLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-363-1003
Mailing Address - Street 1:7300 SANDLAKE COMMONS BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8050
Mailing Address - Country:US
Mailing Address - Phone:407-363-1003
Mailing Address - Fax:407-351-7732
Practice Address - Street 1:7300 SANDLAKE COMMONS BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8050
Practice Address - Country:US
Practice Address - Phone:407-363-1003
Practice Address - Fax:407-351-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 45967174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02948OtherBLUE CROSS BLUE SHIELD
FL370028300Medicaid
FLD50689Medicare UPIN