Individual
MICHAEL D PENTALERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3402 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6214
(813) 875-3950
(813) 872-2741
Mailing address
PO BOX 102222, ATLANTA, GA 30368-2222
(392) 748-2002
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME78641
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME78641
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003156073A
GA MEDICAID
GA
05
—
259013100
—
FL
01
—
301630
AVMED
FL
01
—
35376
BCBS
FL
01
—
P00301196
MEDICARE RAILROAD
FL
01
—
P01130437
RR MEDICARE
FL
Enumeration date
04/27/2006
Last updated
02/29/2024
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