Healthcare Provider Details

I. General information

NPI: 1841005899
Provider Name (Legal Business Name): ORACLE SPINE AND ORTHOPEDICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 GRIFFIN RD STE 107
DAVIE FL
33328-3208
US

IV. Provider business mailing address

772 NW 82ND TER
PLANTATION FL
33324-1235
US

V. Phone/Fax

Practice location:
  • Phone: 954-295-9753
  • Fax: 954-301-3901
Mailing address:
  • Phone: 954-328-9441
  • Fax: 954-301-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL C WEISS
Title or Position: CEO
Credential: DO
Phone: 954-295-9753