Healthcare Provider Details

I. General information

NPI: 1912960006
Provider Name (Legal Business Name): MICHAEL R ENRICO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 N FEDERAL HWY STE 800
FORT LAUDERDALE FL
33308-1409
US

IV. Provider business mailing address

127 RED OAK DR
MANKATO MN
56001-8996
US

V. Phone/Fax

Practice location:
  • Phone: 954-837-2362
  • Fax:
Mailing address:
  • Phone: 775-354-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number61281
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number333055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: