| Doctor Name: | DR. MICHAEL DOMINIC MOZZETTI |
| NPI Number: | 1265591259 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME69032 |
| Business Practice Address: | 22655 Bayshore Rd Suite120 Port Charlotte, FL - 339802005 |
| Business Phone Number: | 9416291218 |
| Business Fax Number: | 9416259465 |
| Mailing Address: | 22655 Bayshore Rd, Suite120 PORT CHARLOTTE |
| State: | FL |
| Postal Code: | 339802005 |
| Phone Number: | 9416291218 |
| Fax Number: | 9416259465 |
| NPI Enumeration Date: | 12/06/2006 |
| NPI Last Update Date: | 05/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME69032 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |