Healthcare Provider Details

I. General information

NPI: 1427120294
Provider Name (Legal Business Name): MAGDALENA EWA MISIUREK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 HANOVER CT
LAKELAND FL
33813-4733
US

IV. Provider business mailing address

730 HANOVER CT
LAKELAND FL
33813-4733
US

V. Phone/Fax

Practice location:
  • Phone: 863-800-7296
  • Fax:
Mailing address:
  • Phone: 863-800-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME96947
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME96947
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME96947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: