Mitchell Lee Petusevsky, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

FLME0042752 Issued in FL

Practice address

700 2ND Ave N
Suite 305
Naples, FL 34102-5756

Phone

(239) 263-8385

Fax

(239) 263-8592

NPI assigned

May 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  Medicare reassignment NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Brooksville, FL
  • NPI 1073131702
  NPD
• Collier Hma Physician Management LLC

  • Internal Medicine Physician
  • Naples, FL
  • NPI 1245282979

  Pulmonary Disease

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393804800000",
    "number": "1275584435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 HANCOCK BRIDGE PKWY",
            "address_2": "SUITE 301",
            "city": "NORTH FORT MYERS",
            "state": "FL",
            "postal_code": "339037094",
            "telephone_number": "877-856-3774",
            "fax_number": "239-599-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 2ND AVE N",
            "address_2": "SUITE 305",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341025756",
            "telephone_number": "239-263-8385",
            "fax_number": "239-263-8592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETUSEVSKY",
        "first_name": "MITCHELL",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2014-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "FL",
            "license": "FLME0042752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064860400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roodelyne Petit-Homme
• Marissa M Petralia, PH.D.
• Kyndra Lynn Petrick, ARNP
• Michael John Petrocelli, D.P.M.
• Riley Joshua Petrovich
• Elizabeth M Pezzello
• David Lawrence Pezzullo, MHCI
• Rosemarie Anne Pezzullo, M.D.
• Elizabeth McKenna Pfent, DMD
• Christopher Joseph Pham, DO

• Pulmonary Disease Physician in Naples, FL
• Providers in Naples, FL by specialty
• Pulmonary Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.