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Individual

DR. MICHAEL SCOTT PORTILLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
300 PINELLAS ST, CLEARWATER, FL 33756-3804
(727) 462-7000
Mailing address
PO BOX 917368, ORLANDO, FL 32891-0001
(727) 441-3711

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD00049340
WA
2085R0202X
Diagnostic Radiology Physician
Primary
ME93865
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001026200
FL
01
1454D
BCBS
FL
01
P00788707
RR MEDICARE
FL
Enumeration date
06/06/2008
Last updated
12/02/2011
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