Healthcare Provider Details

I. General information

NPI: 1023168739
Provider Name (Legal Business Name): MICHAEL JOHAN SCHOU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW 95 ST 2ND FLOOR ADVANCE PAIN MANAGEMENT OF FLORIDA INC
MIAMI FL
33150-2098
US

IV. Provider business mailing address

1100 NW 95 ST 2ND FLOOR ADVANCE PAIN MANAGEMENT OF FLORIDA INC
MIAMI FL
33150-2098
US

V. Phone/Fax

Practice location:
  • Phone: 305-694-3775
  • Fax: 305-694-3678
Mailing address:
  • Phone: 305-694-3775
  • Fax: 305-694-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME38962
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME38962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: