Healthcare Provider Details

I. General information

NPI: 1750359451
Provider Name (Legal Business Name): M MICHAEL AKHIYAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 SAINT JOHNS AVE SUITE A
PALATKA FL
32177-6857
US

IV. Provider business mailing address

6061 SAINT JOHNS AVE SUITE A
PALATKA FL
32177-6857
US

V. Phone/Fax

Practice location:
  • Phone: 386-325-0826
  • Fax: 386-325-6419
Mailing address:
  • Phone: 386-325-0826
  • Fax: 386-325-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0059459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: