Individual
MICHAEL A ADDONIZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 LAKELAND HILLS BLVD, LAKELAND, FL 33805-3019
(863) 680-7000
(866) 264-8519
Mailing address
PO BOX 95004, LAKELAND, FL 33804-5004
(863) 680-7000
(863) 680-7420
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
ME77311
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME77311
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268845000
—
FL
01
—
46533
BCBS OF FLORIDA
FL
01
—
P00105239
RR MEDICARE
FL
Enumeration date
06/30/2005
Last updated
06/21/2012
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