| Doctor Name: | MICHAEL MEDLIN |
| NPI Number: | 1619339561 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | ISW 10516 |
| Business Practice Address: | 6629 Lake Erie Rd Groveland, FL - 347369774 |
| Business Phone Number: | 8507272329 |
| Business Fax Number: | |
| Mailing Address: | 6629 Lake Erie Rd, GROVELAND |
| State: | FL |
| Postal Code: | 347369774 |
| Phone Number: | 8507272329 |
| Fax Number: | |
| NPI Enumeration Date: | 03/21/2016 |
| NPI Last Update Date: | 03/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | ISW 10516 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |