Michael C. Ianniello, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MICHAEL C. IANNIELLO, DO

Practice address

2560 Judge Fran Jamieson Way Unit 1313
Melbourne, FL 32940

Phone

(954) 235-3752

NPI assigned

Jun 28, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Michael Ianniello, DO

Title

Owner, Physician

Phone

(954) 235-3752

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569456000000",
    "number": "1407142425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 JUDGE FRAN JAMIESON WAY UNIT 1313",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329406199",
            "telephone_number": "954-235-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 JUDGE FRAN JAMIESON WAY UNIT 1313",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32940",
            "telephone_number": "954-235-3752"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5205 Babcock St NE Ste 3",
            "address_purpose": "LOCATION",
            "city": "Palm Bay",
            "state": "FL",
            "postal_code": "329054638",
            "country_code": "US",
            "telephone_number": "321-729-1400",
            "fax_number": "321-728-5700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MICHAEL C. IANNIELLO, DO",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-28",
        "last_updated": "2019-09-26",
        "status": "A",
        "authorized_official_last_name": "IANNIELLO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER, PHYSICIAN",
        "authorized_official_telephone_number": "954-235-3752",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279400400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Melbourne, FL
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.