Basic Information
| Provider Information | |||||||||
| NPI: | 1841279486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALLINA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 TAMIAMI TRL S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342852614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414842602 | ||||||||
| FaxNumber: | 9414843748 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 TAMIAMI TRL S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342852614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414842602 | ||||||||
| FaxNumber: | 9414843748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | PO3070 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | PO3070 | 01 | FL | FLORIDA LICENSE NUMBER | OTHER |