Individual
DR. MICHAEL PENNACHIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
640 S LAKE ST, LEESBURG, FL 34748-5927
(352) 728-1717
(352) 728-8467
Mailing address
1100 S GROVE ST, EUSTIS, FL 32726-5524
(352) 728-1717
(352) 728-8467
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME0045426
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4779733 003
CIGNA
—
01
—
CC4829
RAILROAD MEDICARE
FL
Enumeration date
07/05/2006
Last updated
03/03/2008
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