NPIMap

Organization Active NPI

Michelle Pennie MD LLC

  • Dermatology Physician
  • Englewood, FL
National Provider Identifier
1558620385
Registry record updated May 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
ME108521 Issued in FL
Legal business name
MICHELLE PENNIE MD LLC
Practice address
900 Pine St
Ste 122-123
Englewood, FL 34223-4418
Phone
(941) 474-8811
Fax
(941) 473-0058
NPI assigned
May 14, 2012
Last updated
May 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2013

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

Authorized official

Name
Michelle Lundeen Pennie, MDNPI 1497932784
Title
Owner
Phone
(941) 474-8811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X ME108521 FL Primary

Addresses

Primary practice location

900 Pine St
Ste 122-123
Englewood, FL 34223-4418

Mailing address

900 Pine St
Suite 123
Englewood, FL 34223-4418
Phone (941) 474-8811

Other identifiers 1

IdentifierTypeStateIssuer
ME108521OtherFLSTATE MEDICAL LICENSE

National Provider Directory

National Provider Directory

Locations

699 S Indiana Ave
Englewood, FL 34223
Phone (941) 474-8811

900 Pine St
Ste 122
Englewood, FL 34223
Phone (941) 225-8189

900 Pine St
Ste 122123
Englewood, FL 34223
Phone (941) 225-8189

900 Pine St
Ste 123
Englewood, FL 34223
Phone (941) 474-4061

3355 Clark Rd
Ste 101
Sarasota, FL 34231
Phone (941) 921-4131

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1336953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369872000000",
    "number": "1558620385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 PINE ST",
            "address_2": "SUITE 123",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234418",
            "telephone_number": "941-474-8811",
            "fax_number": "941-473-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 PINE ST",
            "address_2": "STE 122-123",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234418",
            "telephone_number": "941-474-8811",
            "fax_number": "941-473-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE PENNIE MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-14",
        "last_updated": "2013-05-30",
        "status": "A",
        "authorized_official_last_name": "PENNIE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "LUNDEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-474-8811",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME108521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "ME108521",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2013; 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.