Healthcare Provider Details

I. General information

NPI: 1225904022
Provider Name (Legal Business Name): PETROS OGBAMICHAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8827 SW 123RD CT APT 201
MIAMI FL
33186-1996
US

IV. Provider business mailing address

8827 SW 123RD CT APT 201
MIAMI FL
33186-1996
US

V. Phone/Fax

Practice location:
  • Phone: 786-554-4170
  • Fax:
Mailing address:
  • Phone: 786-554-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: