Healthcare Provider Details

I. General information

NPI: 1679193445
Provider Name (Legal Business Name): PONCELET MICHEL MD, PA.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PONCELET MICHEL MD, PA.

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 NW 183RD ST
MIAMI FL
33169-4469
US

IV. Provider business mailing address

581 NW 183RD ST
MIAMI FL
33169-4469
US

V. Phone/Fax

Practice location:
  • Phone: 305-651-1690
  • Fax:
Mailing address:
  • Phone: 305-651-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number483-P.A.
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberNJDCATEMP000848
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberACN1720
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberNJDCATEMP000856
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: