Healthcare Provider Details

I. General information

NPI: 1497852057
Provider Name (Legal Business Name): DAVID C MISHKEL MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GLADES RD SUITE 200 EAST TOWER
BOCA RATON FL
33431-7386
US

IV. Provider business mailing address

2300 GLADES RD SUITE 200 EAST TOWER
BOCA RATON FL
33431-7386
US

V. Phone/Fax

Practice location:
  • Phone: 561-338-8884
  • Fax: 561-338-5230
Mailing address:
  • Phone: 561-338-8884
  • Fax: 561-338-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME66416
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME66416
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID CHARLES MISHKEL
Title or Position: PRESIDENT
Credential: MD
Phone: 561-338-8884