Active NPI
Atlantic ENT LLC
- Otolaryngic Allergy Physician
- Cocoa Beach, FL
National Provider Identifier
1427203348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngic Allergy Physician
- License
- ME0061454
- Legal business name
- ATLANTIC ENT LLC
- Practice address
- 333 W Cocoa Beach Cswy Ste B
Cocoa Beach, FL 32931-3513 - Phone
- (321) 799-9797
- Fax
- (321) 799-3393
- NPI assigned
- Nov 19, 2008
- Last updated
- Nov 19, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Michael Paul Widick, M.D.
- Title
- Sole MBR
- Phone
- (321) 799-9797
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngic Allergy Physician | 207YX0602X | ME0061454 | FL | Primary |
Addresses
Primary practice location
333 W Cocoa Beach Cswy Ste B
Cocoa Beach, FL 32931-3513
Mailing address
333 W Cocoa Beach Cswy Ste B
Cocoa Beach, FL 32931-3513
Phone (321) 799-9797
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
333 W Cocoa Beach Cswy
Ste B
Cocoa Beach, FL 32931
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Audiologist
- Cocoa Beach, FL
- NPI 1780805457
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1227052800000",
"number": "1427203348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 W COCOA BEACH CSWY STE B",
"city": "COCOA BEACH",
"state": "FL",
"postal_code": "329313513",
"telephone_number": "321-799-9797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 W COCOA BEACH CSWY STE B",
"city": "COCOA BEACH",
"state": "FL",
"postal_code": "329313513",
"telephone_number": "321-799-9797",
"fax_number": "321-799-3393"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ATLANTIC ENT LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-11-19",
"last_updated": "2008-11-19",
"status": "A",
"authorized_official_last_name": "WIDICK",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "PAUL",
"authorized_official_title_or_position": "SOLE MBR",
"authorized_official_telephone_number": "321-799-9797",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207YX0602X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otolaryngic Allergy",
"state": "FL",
"license": "ME0061454",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cocoa Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.