Healthcare Provider Details

I. General information

NPI: 1750514899
Provider Name (Legal Business Name): MICHAEL NEAL BAXLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 NW 131ST ST
HIALEAH GARDENS FL
33018-1658
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 904-891-6913
  • Fax: 786-953-7060
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME0069190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: