Provider Demographics
NPI:1376584615
Name:GORDON, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2471
Mailing Address - Country:US
Mailing Address - Phone:941-955-6748
Mailing Address - Fax:941-953-6023
Practice Address - Street 1:943 S BENEVA RD STE 106
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2471
Practice Address - Country:US
Practice Address - Phone:941-955-6748
Practice Address - Fax:941-953-6023
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93449207X00000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273705100Medicaid
FL28727ZMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
FL273705100Medicaid
FLI40157Medicare UPIN