Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN15608 | FL |
NPI | 1134344963 |
---|---|
Provider Name | Michael Adam Pawlus |
First Address | Sarasota, FL 34231 |
Second Address | Sarasota, FL 34231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |