Provider Demographics
NPI:1992994446
Name:PATETE, MICHAEL LOUIS (MD, FACS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
Last Name:PATETE
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 PALERMO PL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2821
Mailing Address - Country:US
Mailing Address - Phone:941-485-7783
Mailing Address - Fax:941-484-9188
Practice Address - Street 1:213 PALERMO PL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2821
Practice Address - Country:US
Practice Address - Phone:941-485-7783
Practice Address - Fax:941-484-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23201Medicare PIN
FLF66274Medicare UPIN