Healthcare Provider Details

I. General information

NPI: 1265417695
Provider Name (Legal Business Name): MICHAEL DIGIORGIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S PERIMETER RD SUITE 180
FORT LAUDERDALE FL
33309-7139
US

IV. Provider business mailing address

PO BOX 223293
PITTSBURGH PA
15251-2293
US

V. Phone/Fax

Practice location:
  • Phone: 954-839-8080
  • Fax: 954-839-8081
Mailing address:
  • Phone: 844-699-0003
  • Fax: 855-812-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME87079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: