Healthcare Provider Details

I. General information

NPI: 1831105485
Provider Name (Legal Business Name): MICHAEL S URBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 LAKE WORTH RD 2ND FLOOR
LAKE WORTH FL
33467-2948
US

IV. Provider business mailing address

P.O. BOX 740177
BOYNTON BEACH FL
33474-0177
US

V. Phone/Fax

Practice location:
  • Phone: 561-434-0060
  • Fax: 561-434-0598
Mailing address:
  • Phone: 561-740-2900
  • Fax: 561-434-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0057388
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: