Organization
MICHELLE PENNIE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE LUNDEEN PENNIE MD (OWNER)
(941) 474-8811
Entity
Organization
Contact information
Practice address
900 PINE ST, STE 122-123, ENGLEWOOD, FL 34223-4418
(941) 474-8811
(941) 473-0058
Mailing address
900 PINE ST, SUITE 123, ENGLEWOOD, FL 34223-4418
(941) 474-8811
(941) 473-0058
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME108521
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME108521
STATE MEDICAL LICENSE
FL
Enumeration date
05/14/2012
Last updated
05/30/2013
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