Healthcare Provider Details

I. General information

NPI: 1750708780
Provider Name (Legal Business Name): MICHAEL ANDREW CUDWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 420
HIALEAH FL
33013-3835
US

IV. Provider business mailing address

777 E 25TH ST STE 420
HIALEAH FL
33013-3835
US

V. Phone/Fax

Practice location:
  • Phone: 305-691-0118
  • Fax:
Mailing address:
  • Phone: 312-996-6765
  • Fax: 312-355-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036144792
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA10886700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME162710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: