Provider Demographics
NPI:1972882777
Name:SWEENEY, MICHAEL JOS (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOS
Last Name:SWEENEY
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 1:2917 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4405
Mailing Address - Country:US
Mailing Address - Phone:904-388-5174
Mailing Address - Fax:
Practice Address - Street 1:2917 GRAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4405
Practice Address - Country:US
Practice Address - Phone:904-247-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 420002086S0129X
LAMD.0149852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery