Healthcare Provider Details

I. General information

NPI: 1588742274
Provider Name (Legal Business Name): MICHAEL MIZRACHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/23/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 ARBOR CLUB WAY APT 7
BOCA RATON FL
33433-5746
US

IV. Provider business mailing address

5716 ARBOR CLUB WAY APT 7
BOCA RATON FL
33433-5746
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-0745
  • Fax:
Mailing address:
  • Phone: 954-544-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME80526
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: