Provider Demographics
NPI:1710104583
Name:MICHAEL T. MCCORMICK & ASSOCIATES PA
Entity type:Organization
Organization Name:MICHAEL T. MCCORMICK & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DPM
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:CLINT
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-493-8666
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:941-493-8666
Mailing Address - Fax:941-497-5411
Practice Address - Street 1:115 SHAMROCK BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1630
Practice Address - Country:US
Practice Address - Phone:941-493-8666
Practice Address - Fax:941-497-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0992150001Medicare NSC
FLK3059Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER