Individual
DR. MICHAEL JOHN PETROCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1715 HERITAGE TRL, SUITE 204, NAPLES, FL 34112-8715
(239) 775-0019
(239) 775-0219
Mailing address
1715 HERITAGE TRL, SUITE 204, NAPLES, FL 34112-8715
(239) 775-0019
(239) 775-0219
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO-2399
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340308400
—
FL
01
—
4544600001
DMERC #
FL
01
—
4574474
AETNA #
FL
01
—
65356
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/03/2005
Last updated
08/25/2009
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