Healthcare Provider Details

I. General information

NPI: 1942389804
Provider Name (Legal Business Name): MARISA MESSORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 ALTON RD STE 320
MIAMI BEACH FL
33140-4559
US

IV. Provider business mailing address

4308 ALTON RD STE 320
MIAMI BEACH FL
33140-4559
US

V. Phone/Fax

Practice location:
  • Phone: 305-673-9444
  • Fax: 305-535-7533
Mailing address:
  • Phone: 305-534-2926
  • Fax: 53-534-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME70081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: