Healthcare Provider Details

I. General information

NPI: 1477668440
Provider Name (Legal Business Name): HODA A MIKHAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 E SAMPLE RD SUITE 101
LIGHTHOUSE POINT FL
33064-7574
US

IV. Provider business mailing address

1100 S FEDERAL HWY
DEERFIELD BEACH FL
33441-7035
US

V. Phone/Fax

Practice location:
  • Phone: 954-418-0118
  • Fax: 954-481-4460
Mailing address:
  • Phone: 954-418-0118
  • Fax: 954-481-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME45309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: